Presentation
Weight loss, abdominal pain and leg swelling. On examination, lower abdominal mass.
Patient Data
Bulky retroperitoneal and left pelvic sidewall lymphadenopathy. Diffuse, smooth, circumferential thickening of the small bowel. Some dilatation of the small bowel too. Small volume of free fluid. Normal upper abdominal solid organs.
Left iliac lymph node biopsy with immunohistochemical analysis showed Burkitt's lymphoma.
Treatment was commenced, and 1 month later, presents with hematemesis. Upper GI endoscopy shows altered blood in stomach and duodenum but no focal site of bleeding. A CT was requested to find a source of bleeding.
Most of the small bowel wall thickening has resolved. There remains bulky lymphadenopathy. A blush of contrast is seen on the arterial phase images within the small bowel approximately 30 cm from the DJ flexure, with dissipation on the venous phase and no high density in the region on the non-contrast phase. This is consistent with a site of active hemorrhage.
Case Discussion
Two separate catheter angiogram studies failed to show a focal bleeding point, and there was no more upper GI tract bleeding. Resolution of the small bowel wall thickening may have left the mucosa in a friable state, causing the bleeding.
Burkitt lymphoma accounts for 1-2% of lymphoma in adults, and 30% have extranodal involvement at presentation.
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