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Intravascular lymphoma (IVL) is a rare subtype of diffuse large B-cell lymphoma characterized by a clonal proliferation of lymphocytes restricted to the intravascular space. We present the case of a 60-year-old man with hemophagocytic syndrome secondary to IVL. 18F-FDG PET/CT demonstrated hepatosplenomegaly with marked diffuse hepatic, splenic, and bone marrow hypermetabolism. The case report illustrates the imaging findings of this uncommon variant of IVL.