Increasing liver function test

 

HISTORY: Increasing liver function test.  Status post heart-lung transplant two years ago.

FINDINGS: Images 1 and 2 are sagittal and transverse sonograms of the

right lobe of the liver demonstrating multiple hypoechoic nodules.There is little enhanced through sound transmission and these lesions

appear as solid masses.

Images 3 and 4 are contrast-enhanced CT scans with narrow windows, again

documenting multiple hypodense hepatic lesions.

DIAGNOSIS: Cyclosporine associated hepatic lymphoma following heart-lung

transplantation.

DISCUSSION: The ultrasound appearance of multiple hypoechoic hepatic

nodules and the CT demonstration of multiple hypodense lesions within the liver is non-specific.  The differential diagnosis includes metastasis, abscess, or lymphoma.  In this patient who is afebrile and

presented only with abnormal liver function tests, fine-needle biopsy of the hepatic lesions revealed non-Hodgkin's lymphoma.  The patient was

taken off cyclosporine and the lesions regressed and no specific

chemotherapy was given.