The 'Starry Sky' liver with Burkitt's lymphoma

Abstract

Two sonographic patterns have been described in diffuse hepatic disease. The 'bright liver' has increased parenchymal echogenicity and sound attenuation associated with a decrease in the number and brightness of portal venule walls. This pattern of diffuse liver disease is found with fatty infiltration, chronic hepatitis, acute alcoholic hepatitis, chronic passive congestion, and cirrhosis. A less common appearance of diffuse liver disease is the 'starry sky' or centrilobular pattern, with increased hepatic sonolucency and accentuation of the portal venule walls. Although classically associated with acute hepatitis, this pattern of diffuse hepatic disease has also been described in conjunction with leukemia and toxic shock syndrome. We recently encountered a case of Burkitt's lymphoma with hepatic involvement which presented with a 'starry sky' appearance on abdominal ultrasound. To our knowledge, this is the first reported case of this hepatic presentation with Burkitt's lymphoma.