KEY FACTS
Terminology
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Neoplasm of lymphoid tissues in liver
Imaging
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No known specific imaging findings for diagnosis of hepatic lymphoma
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Hepatic lymphoma often favors periportal areas due to high content of lymphatic tissue
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Grayscale ultrasound
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Discrete form: Multiple well-defined, hypoechoic masses
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Hypoechogenicity due to high cellular density and lack of background stroma
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Infiltrative form: Innumerable subcentimeter hypoechoic foci, miliary in pattern and periportal in location
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May be indistinguishable from normal liver
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CECT
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Solid lesions with poor contrast enhancement
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Usually homogeneous density and rarely necrotic
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May have thin rim enhancement
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Diffuse, infiltrative, low-density areas
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Top Differential Diagnoses
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Metastases
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Multifocal/diffuse hepatocellular carcinoma (HCC)
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Liver abscesses
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Hemangiomas
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Focal fat infiltration/sparing
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Hepatic cysts
Clinical Issues
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Primary hepatic lymphoma is rare
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Secondary hepatic involvement is more common
Diagnostic Checklist
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Rule out other multiple liver lesions: Metastasis, HCCs, hepatic cysts, abscesses, hemangiomas
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Confirmation may require needle biopsy
Scanning Tips
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Hepatic lymphoma often has pseudocystic appearance; lack of specular reflection of backwall is helpful clue that lesions are not cystic and rather solid markedly hypoechoic masses