CT scans in the diagnosis of lymphadenopathy or hepatosplenomegaly

Role

CT chest/abdomen/pelvis is the standard imaging modality for characterising lymphadenopathy and hepatosplenomegaly in haematological malignancy workup and staging, assessing nodal size, distribution, and involvement of extranodal sites
Central to the initial workup of suspected lymphoma and to staging once a histological diagnosis is confirmed

Nodal size thresholds (generally >1cm short-axis diameter in most nodal stations, with some variation by site) are used as a practical (though imperfect) guide to significant lymphadenopathy - CT cannot reliably distinguish reactive from malignant nodes based on size/appearance alone, which is why tissue biopsy remains necessary for diagnosis

Distribution pattern provides diagnostic clues - widespread, symmetric lymphadenopathy favours lymphoma or a systemic reactive process; localised lymphadenopathy favours a regional infective/malignant process
Splenomegaly and hepatomegaly are assessed by size criteria on CT, relevant to staging (splenic involvement changes lymphoma staging) and to the broader differential (lymphoproliferative disease, myeloproliferative disease, portal hypertension, infection)

CT-based staging (following systems such as the Lugano classification for lymphoma) directly determines treatment planning and is used serially to assess treatment response - though PET-CT has increasingly superseded CT alone for staging and response assessment in FDG-avid lymphomas, given its additional metabolic information (see PET scan)

Lymphoma staging, hepatosplenomegaly differential (lymphoproliferative vs myeloproliferative vs infective vs portal hypertensive), extranodal lymphoma involvement

CT cannot distinguish reactive from malignant lymphadenopathy based on imaging appearance alone - a lymph node above the size threshold still requires tissue biopsy for a definitive diagnosis, and conversely, a normal-sized node does not fully exclude early or non-bulky malignant involvement

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