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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