Another starry sky pattern – A radiopathological diagnosis of primary hepatic lymphoma

We present an interesting case of an elderly malepresenting with pyrexia of unknown origin in whom theimaging findings had a peculiar and characteristic rareappearance simulating a classic pathological diagnosis.On clinical examination patient had hepatomegaly.Biochemical evaluation showed raised bilirubin andalkaline phosphatase (ALP). On ultrasound (USG) imagingthe provisional diagnosis was metastasis as evidenced byhepatomegaly with diffuse inhomogeneous echotextureof liver. The lesions were hypoechoic with no posterioracoustic enhancement [Figure 1A]. Computed Tomography(CT) showed hepatomegaly with diffuse heterogeneousattenuation and multiple small hypodense areas. The lesionsin arterial and portal phase appeared hypoattenuating withno early contrast enhancement. Delayed contrast enhancedsections of liver showed persistent hypoattenuating nodules.