HYPEREOSINOPHILIC SYNDROME - IMAGING FINDINGS IN PATIENTS WITH HEPATIC INVOLVEMENT

OBJECTIVE. Hypereosinophilic syndrome (eosinophilia without demonstrab le cause) commonly involves eosinophilic infiltration of the liver and spleen, but few reports have described the imaging findings. Accordin gly, we reviewed the imaging findings in five patients with this syndr ome in whom the liver was involved. MATERIALS AND METHODS. Five patien ts who had hypereosinophilic syndrome with hepatic involvement were in cluded in the study. The diagnosis of hepatic involvement was based on pathologic proof in two patients and on imaging and laboratory findin gs in the other three. Histologic examination of the hepatic lesions s howed extensive eosinophilic infiltration in two patients and centrilo bular necrosis in one. All patients had chest radiography, barium stud ies of the gastrointestinal tract, abdominal CT, and sonography. Four patients had hepatosplenic scintigraphy. All patients were followed up for 4-24 months. RESULTS. All patients had mild to marked hepatomegal y with multiple focal lesions. Focal lesions were detected on sonogram s in three patients, on CT scans in four, and on scintigrams in three. On sonograms, the lesions were usually small (less than 2 cm in diame ter), sharply or poorly defined nodules with varied echogenicity scatt ered throughout the liver. The lesions were hypodense with poorly defi ned margins on CT scans and appeared as variably sized areas of decrea sed radionuclide uptake on scintigrams. For each patient, the number, size, and shape of the lesions varied considerably from one imaging st udy to another. On follow-up studies 2-6 months after treatment, the a ppearance of the liver was normal. Other radiologic findings included transient pulmonary infiltrates (two patients), mild cardiomegaly (one patient), and mild lymphadenopathy (three patients). CONCLUSION. Hype reosinophilic syndrome is a cause of focal hepatic lesions seen on son ograms, CT scans, or scintigrams. The lesions are characterized by the varied appearance on the different types of images and the disappeara nce of the lesions with treatment.