title: 2D ultrasonography and contrast enhanced ultrasound for the evaluation of cavitating mesenteric lymph node syndrome in a patient with refractory celiac disease and enteropathy T cell lymphoma.
abstract: BACKGROUND
  The cavitating mesenteric lymph node syndrome (CMLNS) is a rare manifestation of celiac disease, with an estimated mortality rate of 50%. Specific infections and malignant lymphoma may complicate its clinical course and contribute to its poor prognosis. Diagnosing the underlying cause of CMLNS can be challenging. This is the first report on contrast enhanced ultrasound (CEUS) findings in enteropathy associated T-cell lymphoma (EATL) complicating CMLNS in a gluten-free compliant patient with persistent symptoms and poor outcome.
  
  
  METHODS
  We present the case of a 51-year old Caucasian male patient, diagnosed with celiac disease and CMLNS. Despite his compliance to the gluten-free diet the symptoms persisted and we eventually considered the possible development of malignancy. No mucosal changes suggestive of lymphoma were identified with capsule endoscopy. Low attenuation mesenteric lymphadenopathy, without enlarged small bowel segments were seen on computed tomography. CEUS revealed arterial rim enhancement around the necrotic mesenteric lymph nodes, without venous wash-out. No malignant cells were identified on laparoscopic mesenteric lymph nodes biopsies. The patient died due to fulminant liver failure 14 months later; the histopathological examination revealed CD3/CD30-positive atypical T-cell lymphocytes in the liver, mesenteric tissue, spleen, gastric wall, kidney, lung and bone marrow samples; no malignant cells were present in the small bowel samples.
  
  
  CONCLUSIONS
  CEUS findings in EATL complicating CMLNS include arterial rim enhancement of the mesenteric tissue around the cavitating lymph nodes, without venous wash-out. This vascular pattern is not suggestive for neoangiogenesis, as arteriovenous shunts from malignant tissues are responsible for rapid venous wash-out of the contrast agent. CEUS failed to provide a diagnosis in this case.
authors: Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 19-21, Croitorilor Street, 400 162, Cluj-Napoca, Romania.
authors: Cristina
authors: C
authors: Pojoga
authors: Lidia
authors: L
authors: Ciobanu
authors: Alexandru Florin
authors: AF
authors: Badea
authors: Emil
authors: E
authors: Boţan
authors: Cosmin
authors: C
authors: Caraiani
authors: Claudia
authors: C
authors: Hagiu
authors: Grigore
authors: G
authors: Băciuţ
authors: Radu
authors: R
authors: Badea
mesh_terms: D002446:Celiac Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D055050:Diet, Gluten-Free; D058527:Enteropathy-Associated T-Cell Lymphoma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017809:Fatal Outcome; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging*; D008875:Middle Aged; D013577:Syndrome; D014463:Ultrasonography / Q000379:methods*
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