What is Your Radiologic Diagnosis?

Radiologic Diagnosis / Radyolojik TanıA five-year-old male patient was admitted to the pediatric oncology outpatient clinic with fever, abdominal pain and malaise.The history revealed that the patient had undergone right hemicolectomy eight months ago due to intussusception, had been diagnosed with Burkitt lymphoma and received the last chemotherapy was given 10 days ago.Physical examination revealed no significant findings.Laboratory tests revealed neutropenia, thrombocytopenia and mild increase in liver enzymes.A focus of infection was investigated with a preliminary diagnosis of neutropenic fever.Abdominal ultrasonography (US) showed several hypoechoic lesions in the liver.For characterization of the lesions, upper abdomen magnetic resonance imaging (MRI) with intravenous contrast was performed.Multiple nodular lesions were seen in the liver (Figures 1,2).What is your diagnosis according to the patient's history and MRI findings? DIAGNOSIS: Fungal InfectionMRI showed T2W hyperintense lesions with indistinct borders distributed in both lobes of the liver, showing diffusion restriction and homogeneous contrast enhancement (Figures 1,2).Lymphoma involvement and fungal infection should be considered in the differential diagnosis of these lesions.Percutaneous biopsy was taken from the lesions for diagnosis.Fungal hyphae were detected on pathological examination, and the patient was diagnosed with invasive fungal infection.After one month of antibiotic and amphotericin-B treatment, the lesions regressed almost completely.