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Multiple focal lesions in liver and spleen in acute leukaemia

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An 18 year old girl presented with a two month history of fever and bleeding tendency. On examination, she had multiple petechial haemorrhages all over her body. There was no organomegaly or peripheral lymphadenopathy. Systemic examination was unremarkable. Total leucocyte count was 117 × 109/l and platelet count 45 × 109/l. Peripheral smear showed presence of blast cells. Bone marrow biopsy revealed 60%–70% myeloblasts. The patient was diagnosed as having myeloid leukaemia. After two cycles of chemotherapy, the patient went into remission.

After three weeks, she became febrile again and developed diffuse upper abdominal tenderness and jaundice. Abdominal sonography (fig 1) and computed tomography (figs 2 and 3) were performed. Total leucocyte count at this time was 9.5 × 109/l.

Figure 1

Sonogram of the spleen shows multiple, rounded hypoechoic lesions, some with typical bull's eye appearance.

Figure 2

Computed tomogram of the upper abdomen showing multiple small low attenuation lesions in the liver and spleen. Incidentally old calcified granulomas are also seen in liver and spleen.

Figure 3

Computed tomogram shows multiple, low attenuation, rounded lesions in the spleen. One of the lesions (arrow) also shows a central nidus of high attenuation.

Questions

(1)
What are the findings on ultrasound and computed tomography?
(2)
What is the radiological diagnosis?
(3)
How can the diagnosis be confirmed?

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Footnotes

  • Dr Sanjay Sharma, A-86, Inderpuri, New Delhi 110012, India (email: ssh{at}medinst.ernet.in)

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