Diagnostic Ultrasound - Abdomen and Pelvis

Hepatic Lymphoma
Diagnoses: Liver
Hemangiomas
• Typically uniformly hyperechoic on US
• May be hypoechoic on underlying fatty liver
• CECT/CEMR: Typical peripheral, nodular, discontinuous
enhancement
• Isodense with blood vessels on CT
• Strong hyperintensity on T2WI
Focal Fat Infiltration/Sparing
• Focal signal dropout on opposed-phase T1 GRE MR
• Vessels course through lesions without disruption
• Typical sites; periligamentous, perivascular distribution
Hepatic Cysts
• Homogeneous, anechoic lesion with posterior acoustic
enhancement
• May have increased echogenicity or density due to prior
bleed or infection (e.g., polycystic liver)
• No central or peripheral rim enhancement
• Imperceptible walls
• No mural nodules or debris
PATHOLOGY
General Features
• Etiology
○ Viral cause suggested
• Associated abnormalities
○ Immunocompromised patients are predisposed to
lymphoma
– Congenital immunodeficiency
– Collagen vascular diseases
– HIV infection/AIDS
– Immunosuppressant therapy for organ transplant
○ Hepatitis B and C virus
Staging, Grading, & Classification
• Ann Arbor staging classification
• NHL classification
○ Revised European American Lymphoma (REAL)
classification
○ World Health Organization (WHO) classification
○ International Working Formulation
Gross Pathologic & Surgical Features
• Miliary, nodular or diffuse form
Microscopic Features
• Hodgkin disease
○ Typical Reed-Sternberg cells
• Non-Hodgkin lymphoma
○ Follicular small cleaved cells (most common)
○ Small noncleaved cells (Burkitt lymphoma; rare)
○ Ascites or pleural effusion
○ Lymphadenopathy: Periportal paraaortic, mesenteric
• Lab data: LFT abnormality, elevated serum lactate
dehydrogenase (LDH)
• Diagnosis: Imaging, occasionally fine-needle aspiration
biopsy
Demographics
• Age
○ Usually middle and older age group
• Gender
○ M > F
• Epidemiology
○ Approximately 60,000 new cases of lymphoma
diagnosed per year in USA
○ Primary hepatic lymphoma is rare
Natural History & Prognosis
• Depends on histological classification and stage of disease
• Liver involvement may lead to fulminant hepatic failure
with rapid progression of encephalopathy to coma and
death
Treatment
• Chemotherapy
○ May be hampered by hepatic insufficiency
• Radiotherapy or surgery
DIAGNOSTIC CHECKLIST
Consider
• Rule out other multiple liver lesions
○ Metastasis, HCCs, hepatic cysts, abscesses, hemangiomas
• Often clue to diagnosis is abnormal hepatic parenchymal
echo pattern associated with splenomegaly and
lymphadenopathy
• Confirmation may require needle biopsy
SELECTED REFERENCES
1. Lu Q et al: Primary non-Hodgkin's lymphoma of the liver: sonographic and CT
findings. Hepatobiliary Pancreat Dis Int. 14(1):75-81, 2015
2. Foschi FG et al: Role of contrast-enhanced ultrasonography in primary
hepatic lymphoma. J Ultrasound Med. 29(9):1353-6, 2010
3. Elsayes KM et al: Primary hepatic lymphoma: imaging findings. J Med
Imaging Radiat Oncol. 53(4):373-9, 2009
4. Stojković MV et al: Color Doppler sonography and angioscintigraphy in
hepatic Hodgkin's lymphoma. World J Gastroenterol. 15(26):3269-75, 2009
5. Castroagudín JF et al: Sonographic features of liver involvement by
lymphoma. J Ultrasound Med. 26(6):791-6, 2007
6. Low G et al: Diagnosis of periportal hepatic lymphoma with contrastenhanced
ultrasonography. J Ultrasound Med. 25(8):1059-62, 2006
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CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Hepatomegaly
○ Right upper quadrant pain
○ Fever, weight loss, night sweats
○ Jaundice
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