Enlarged Para aortic and Ileac Group of Lymphnodes-LYMPHOMA

Enlarged lymphnodes--

This case is biopsy proven follicular lymphoma.  Lymphoma is a neoplastic disease originating from the cells of the immune system; it typically arising within lymph nodes.

Lymphoma can involve all organ systems and site including the abdomen, thorax, pelvis, head and neck, CNS and bone.

Diagnostic imaging - including conventional radiography, US, CT and MR - plays an important role in the diagnosis and staging of lymphoma.  Sonographic evaluation is typically included in the initial workup of patients with abdominal symptoms. Therefore familiarity with the spectrum of US findings associated with lymphoma is essential to making the diagnosis.

• Lymph Nodes-The sonographic appearance of lymphoma is variable, but hypoechoic or anechoic lymph nodes without distal enhancement are typical.  Nodal involvement can be individual or in groups.  Nodal masses may be seen adjacent to the abdominal great vessels, within the retroperitoneum, the prevertebral area and mesentery.  Lymph node encasement of the root of the mesentery and SMA may produce the “sandwich sign”, which is created by the lobulated, confluent mesenteric soft-tissue masses and the tubular structures of the mesenteric vessels and perivascular fat.

• GI tract- Lymphomatous involvement of the bowel produces hypoechoic bowel wall thickening or a focal hypoechoic/complex mass.

• Spleen- Sonographic findings of splenic involvement can include homogeneous splenomegaly and/or solitary nodules that are hypoechoic in comparison to the normal splenic parenchyma.

• Liver- Hepatic US findings are similar to those of the spleen and include hepatomegaly and hypoechoic/anechoic nodules

• Pancreas- Pancreatic involvement may appear as hypoechoic areas of enlargement.  Diffuse enlargement of the pancreas has been reported, possibly due to direct infiltration.  Peripancreatic lymph nodes may invade or distort the pancreas. 

• Kidneys- Renal US findings can appear as hypoechoic/anechoic nodules which may be mistaken for renal cysts; however, there is a lack of distal enhancement suggesting that the mass is solid.              

In this case, further evaluation with Contrast Enhanced CT was performed. It shows multiple moderately enlarged mesenteric lymph nodes which correlate with the ultrasound findings above.