Presentation
Presented with upper gastrointestinal bleeding.
Patient Data
Limited non-contrast study shows marked dilatation involving the lumen of the proximal jejunal loop with asymmetrical and circumferential wall thickening (more than 1.5 cm), associated with multiple mesenteric lymph nodes enlargement (some of these lymph nodes show calcification as sequelae of post-treatment/radiotherapy), there is minimal adjacent fat stranding. features are in keeping with aneurysmal dilatation of the jejunum due to lymphomatous involvement(containing mixed oral contrast and fecal material).
No bowel obstruction, despite the large jejunal dilatation.
NB: small lytic bony lesion in the left iliac bone and dots of calcification involving pancreas.
After two months; there is marked increase in aneurysmal dilatation of the jejunum and also regarding the enlarged mesenteric and retroperitoneal lymph nodes, with interval hepatosplenomegaly. Features are consistent with disease progression.
Case Discussion
Known case of diffuse large B cell lymphoma, received multiple lines of chemotherapy. Diffuse large B-cell lymphoma is the most common form of non-Hodgkin lymphoma.
The small bowel is the second most common area to be involved in gastrointestinal lymphoma (after the stomach), where the ileum is the most site for recurrence.
The differential diagnosis is small bowel adenocarcinoma, it shows more surrounding fat planes, less bulky lymph nodes and is associated with intestinal obstruction.
Also another differential diagnosis gastrointestinal stromal tumor, it is not associated with lymphadenopathy.
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