Another starry sky pattern – A radiopathological diagnosis of primary hepatic lymphoma

Abstract

We present an interesting case of an elderly male
presenting with pyrexia of unknown origin in whom the
imaging findings had a peculiar and characteristic rare
appearance simulating a classic pathological diagnosis.
On clinical examination patient had hepatomegaly.
Biochemical evaluation showed raised bilirubin and
alkaline phosphatase (ALP). On ultrasound (USG) imaging
the provisional diagnosis was metastasis as evidenced by
hepatomegaly with diffuse inhomogeneous echotexture
of liver. The lesions were hypoechoic with no posterior
acoustic enhancement [Figure 1A]. Computed Tomography
(CT) showed hepatomegaly with diffuse heterogeneous
attenuation and multiple small hypodense areas. The lesions
in arterial and portal phase appeared hypoattenuating with
no early contrast enhancement. Delayed contrast enhanced
sections of liver showed persistent hypoattenuating nodules.