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This 75 year-old female with known chronic lymphocytic leukemia presented in extremis with abdominal pain, abdominal distention, acidosis and elevated lactate. A CT was performed for possible ischemic colitis.
There is cecal pneumatosis and dilatation consistent with ischemia. There is also a mesenteric and para-aortic nodal mass with the hamburger sign suggesting lymphoma.
Americans may try to tell you this is the sandwich sign. The sign is specific for mesenteric lymphoma (typically non-Hodgkin) unless the patient has had a transplant. If so, posttransplant lymphoproliferative disorder should be considered.