Non-Hodgkin's lymphoma

HISTORY: Known non-Hodgkin's lymphoma with left upper quadrant pain.

FINDINGS: Images 1-5 are longitudinal and transverse scans of the upper

abdomen including images of the liver, pancreas, and kidney.  Images 1

and 2 are transverse scans of the liver demonstrating diffuse hypoechoic

infiltration of the left hepatic lobe.  Note intrahepatic bile duct

dilatation within the medial segment of the left lobe.  Image 3 is a

transverse scan of the pancreas demonstrating multiple hypoechoic masses

(arrows) involving the body and tail of the pancreas.  Images 4 and 5

are sagittal scans of the left kidney demonstrating complete loss of

architecture of the left kidney with hypoechoic masses replacing the

parenchyma.

Images 6-8 are contrast-enhanced CT scans of the upper abdomen

confirming multiple low density masses involving the liver, pancreas,

and left kidney.

DIAGNOSIS: Non-Hodgkin's lymphoma involving the liver, kidney, and

pancreas.

DISCUSSION: Abdominal lymphoma is typically hypoechoic with sonography.

The multicentric involvement in this case is unusual given the relative

paucity of nodal disease.  The visceral involvement is much more

commonly encountered with non-Hodgkin's lymphoma.  AIDS-related

lymphoma will frequently demonstrate this degree of visceral involvement

in the absence of large bulky nodal disease.  Included in the differential

diagnosis are metastatic adenocarcinoma, melanoma, and sarcoma