Presentation
Long-standing epigastric discomfort with newly found left-sided cervical swelling.
Patient Data
Multiple enlarged lymph nodes in level-II, III and IV on the left side of the neck with the largest of about 39 mm (SAD) compressing the left internal jugular vein (with luminal stenosis) and abutting left common carotid artery (without luminal narrowing or thrombus formation) and left lobe of the thyroid gland.
Slice through the chest shows an azygos lobe with an azygos fissure (normal variant).
There is an irregular and asymmetric increase in wall-thickness (up to about 23 mm in maximum size on the posterior aspect at the esophagogastric junction) of the esophagogastric junction, gastric fundus, cardia and body along the lesser and greater curvature with significant surrounding fat stranding but no visible invasion of the adjacent organs.
Multiple, enlarged lymph nodes are seen in peri-gastric, peri-pancreatic regions in the vicinity of the SMA and porta-hepatis with the largest oo of about 20 mm (SAD).
Enlarged lymph nodes in the form of nodular, matted and conglomerate lesions in the pre/para-aortic regions and aortocaval window are also appreciated which are encasing abdominal aorta (with significant luminal narrowing or thrombus formation).
Case Discussion
CT findings are of gastric wall malignant mass lesion with extensive abdominal and left supra-clavicular lymphadenopathy also referred to as Troisier sign/Virchow node (cT3N3bM1).
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