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Table 2 Differentials of various morphological types of hepatic lymphoma

From: The imaging conundrum of hepatic lymphoma revisited

Morphological Type Differentials Distinguishing feature(s)
Solitary discrete lesion Cyst - Posterior acoustic enhancement on US
Abscess - Mobile internal echoes, septations and heterogeneity on US
- Reactive right pleural effusion, ascites and caecal wall thickening
- Presence of surrounding edema and pylephlebitis
- Absence of vessel penetration sign
Hepatocellular carcinoma (HCC) - Arterial phase enhancement
- Venous invasion/thrombosis
- Raised alpha-fetoprotein levels
Focal nodular hyperplasia - Homogeneous enhancement
Intrahepatic cholangiocarcinoma - Capsular retraction
- Mass effect in the form of biliary dilatation and vascular displacement
- Increased CA-19.9 levels
Multifocal lesions Tuberculosis - Necrotic rim-enhancing lymph nodes
- Lung parenchymal involvement
Sarcoidosis -T2-hypointense nodules
- Pulmonary involvement
- Hilar lymphadenopathy
Fungal microabscesses - Perilesional edema
- History of immunosuppression
- High-grade fever with increased white blood cell count
Septic emboli - Known source of infection
- Clinical features of sepsis
Metastases - Known primary malignancy
Diffuse infiltration Infiltrative HCC - Venous invasion/thrombosis
- Markedly raised alpha-fetoprotein levels
- Often non-avid on FDG PET-CT
Acute viral hepatitis - Echogenic periportal cuffing on US
- Normal or mildly elevated LDH levels
- Significant elevation of transaminases
Periportal mass Periportal edema - Echogenic on US
- History of trauma, surgery
Biliary dilatation - Anechoic tubular structures on US
- Absence of complete encasement of portal venous radicals