Diagnostic Ultrasound - Abdomen and Pelvis

Hepatic Lymphoma
Diagnoses: Liver
TERMINOLOGY
• Neoplasm of lymphoid tissues in liver
IMAGING
• Hepatic lymphoma often favors periportal areas due to
high content of lymphatic tissue
• Grayscale ultrasound
○ Discrete form: Multiple well-defined, hypoechoic masses
– Hypoechogenicity due to high cellular density and lack
of background stroma
○ Infiltrative form:Innumerable subcentimeter hypoechoic
foci, miliary in pattern and periportal in location
– May be indistinguishable from normal liver
• CECT
○ Solid lesions with poor contrast enhancement
○ Usually homogeneous density and rarely necrotic
○ May have thin rim enhancement
○ Diffuse infiltrative low-density areas
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Metastases
• Multifocal/diffuse hepatocellular carcinoma (HCC)
• Liver abscesses
• Hemangiomas
• Focal fat infiltration/sparing
• Hepatic cysts
CLINICAL ISSUES
• Primary hepatic lymphoma is rare
• Secondary hepatic involvement is more common
DIAGNOSTIC CHECKLIST
• Rule out other multiple liver lesions: Metastasis, HCCs,
hepatic cysts, abscesses, hemangiomas
• Confirmation may require needle biopsy
(Left) Transverse color
Doppler ultrasound in a
patient with lymphoma
involving the liver shows
multiple hypoechoic masses
ſt in a periportal distribution
(right anterior portal vein)
in the liver. Lesions are
predominantly hypovascular
with minimal vascularity seen
along the periphery st. (Right)
Transverse abdominal
grayscale ultrasound in a
patient with lymphoma shows
several hypoechoic masses ſt
in a periportal distribution in
the left lobe of the liver.
(Left) Transverse abdominal
grayscale ultrasound in the
same patient shows a welldefined,
hypoechoic mass ſt
with a thin, hyperechoic rim
in segment 5 of the liver.
(Right) Transverse color
Doppler ultrasound performed
in the same patient shows no
detectable vascular flow
within the lymphomatous
mass ſt.
256
http://radiologyebook.com/