Abdominal pain

HISTORY: A 26-year-old female with vague upper abdominal pain and

increasing fatigue.

FINDINGS: Images 1 and 2 are transverse scans of the liver demonstrating

numerous hypoechoic lesions.  The background liver echogenicity appears

to be slightly increased suggesting possible underlying fatty

infiltration.

Images of the spleen demonstrate multiple, hypoechoic, ill-defined

masses (Images 3 and 4).

DIAGNOSIS: Low-grade non-Hodgkin's lymphoma with involvement of the

liver and spleen.

DISCUSSION: The combination of focal hepatic and splenic lesions should

always raise the possibility of lymphoma in a young adult.  Hepatic

involvement is typical of AIDS-related lymphoma, and up to 45% of

patients with AIDS-related lymphoma will have hepatic lesions.  Although

the splenic lesions are well seen in this case, sonography is relatively

insensitive for the diagnosis of the splenic involvement in lymphoma.

Often the lymphomatous nodules are only microscopic in nature and cannot

be readily visualized.  The differential diagnosis includes metastatic

carcinoma, particularly ovarian carcinoma, which has a propensity to

involve the spleen.