2D ultrasonography and contrast enhanced ultrasound for the evaluation of cavitating mesenteric lymph node syndrome in a patient with refractory celiac disease and enteropathy T cell lymphoma

BMC Gastroenterology

Case Report

Alexandru Florin Badea¹  Emil Boţan²  Cosmin Caraiani²  Cristina Pojoga²  Radu Badea³  Claudia Hagiu³  Lidia Ciobanu³  Grigore Băciuţ³ 

[1] “Iuliu Hatieganu” University of Medicine and Pharmacy, 8, Victor Babes Street, 400 012, Cluj-Napoca, Romania;“Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 19-21, Croitorilor Street, 400 162, Cluj-Napoca, Romania;“Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 19-21, Croitorilor Street, 400 162, Cluj-Napoca, Romania;“Iuliu Hatieganu” University of Medicine and Pharmacy, 8, Victor Babes Street, 400 012, Cluj-Napoca, Romania;

关键词: CEUS;    Celiac disease;    Peripheral T-cell lymphoma;    Cavitating mesenteric lymph node syndrome;   

DOI  :  10.1186/1471-230X-13-26

 received in 2012-07-15, accepted in 2013-02-06,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe cavitating mesenteric lymph node syndrome (CMLNS) is a rare manifestation of celiac disease, with an estimated mortality rate of 50%. Specific infections and malignant lymphoma may complicate its clinical course and contribute to its poor prognosis. Diagnosing the underlying cause of CMLNS can be challenging. This is the first report on contrast enhanced ultrasound (CEUS) findings in enteropathy associated T-cell lymphoma (EATL) complicating CMLNS in a gluten-free compliant patient with persistent symptoms and poor outcome.Case presentationWe present the case of a 51-year old Caucasian male patient, diagnosed with celiac disease and CMLNS. Despite his compliance to the gluten-free diet the symptoms persisted and we eventually considered the possible development of malignancy. No mucosal changes suggestive of lymphoma were identified with capsule endoscopy. Low attenuation mesenteric lymphadenopathy, without enlarged small bowel segments were seen on computed tomography. CEUS revealed arterial rim enhancement around the necrotic mesenteric lymph nodes, without venous wash-out. No malignant cells were identified on laparoscopic mesenteric lymph nodes biopsies. The patient died due to fulminant liver failure 14 months later; the histopathological examination revealed CD3/CD30-positive atypical T-cell lymphocytes in the liver, mesenteric tissue, spleen, gastric wall, kidney, lung and bone marrow samples; no malignant cells were present in the small bowel samples.ConclusionsCEUS findings in EATL complicating CMLNS include arterial rim enhancement of the mesenteric tissue around the cavitating lymph nodes, without venous wash-out. This vascular pattern is not suggestive for neoangiogenesis, as arteriovenous shunts from malignant tissues are responsible for rapid venous wash-out of the contrast agent. CEUS failed to provide a diagnosis in this case.

【 授权许可】

Unknown   
© Pojoga et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.