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What is the most likely process involving the ileum?
Lymphoma / lymphoproliferative disorder.
What features suggest these diagnoses?
The marked mural thickening with associated dilatation of the lumen is a relatively characteristic appearance of intestinal lymphoma / lymphoproliferative disease.
CT of the abdomen obtained without intravenous contrast demonstrates marked thickening of the terminal ileum, with dilatation of the lumen (despite how thick the wall has become). There is surrounding stranding and numerous enlarged regional lymph nodes.
A right iliac fossa transplant kidney is also noted.