Ultrasound appearances of extramedullary haematopoiesis in the liver and spleen

Abstract

Extramedullary haematopoiesis is an uncommon finding in the adult patient. Many sites have been described, the liver and spleen being more common. The ultrasound appearances have not been well documented. Two cases of extramedullary haematopoiesis in the liver and spleen are presented. A 58-year-old man presented with a history of a cough, haemoptysis, dyspnoea and weight loss. On examination he had finger clubbing, no significant chest signs and hepatomegaly. A bronchial neoplasm was suspected clinically and the initial chest radiograph demonstrated a right lung mass adjacent to the hilum. Full blood count was normal and the erythrocyte sedimentation rate was raised at 52 mm/h. Bronchoscopy revealed extrinsic compression of the right upper lobe bronchus but biopsy was unsuccessful. Ultrasound examination of the abdomen demonstrated multiple echogenic lesions in an enlarged liver (Fig. 1). Some of these lesions contained central echo-poor areas. The spleen was of normal size, and contained one echogenic mass similar to those in the liver. No other abnormality was shown in the remainder of the abdomen and pelvis. The most likely diagnosis for these lesions was metastatic carcinoma. Ultrasound-guided Trucut biopsy was performed. The lesion chosen was peripheral and without any central echopoor area. Histology revealed immature and mature cells of the myeloid and erythroid series with occasional megakaryocytes. Dilated sinusoids and portal tracts contained pleomorphic infiltrate. These are the features of hepatic extramedullary haematopoiesis. An isotope bone scintigram using 99Tcm MDP revealed multiple hot spots in the femora, ribs, skull and spine, interpreted as being metastases.