59-year-old female:
– Presented with weight loss (35 kg weight loss in 1 year)
– Diagnosed with celiac disease 2 years ago
– Laboratory findings: low levels of sodium, potassium, chloride, and calcium in the blood
What do you see?
What so you see?
Multiple mesenteric lymphadenopathies that contain fat-fluid levels (red arrows)
Splenic atrophy (red arrows)
What is the most likely diagnosis?
What is the most likely diagnosis?
Cavitating mesenteric lymph node syndrome
Teaching points
– Cavitating mesenteric lymph node syndrome is associated with celiac disease
– It is characterized by the triad:
(a) low attenuation lymphadenopathies that may contain fat-fluid levels
(b) splenic atrophy
(c) villous atrophy
– Cavitating mesenteric lymph node syndrome is associated with poor prognosis
– Many patients die of complications of cachexia and intestinal hemorrhage. Patients are prone to sepsis, often due to infections commonly associated with clinical hyposplenism, such as pneumococcal infection
– Treatment: Correction of electrolyte abnormalities, strict gluten-free diet, steroid therapy
– In our case, US-guided biopsy of one of the mesenteric lymphadenopathies was performed. Histopathologic examination showed acellular, chylous fluid. It was negative for malignancy or mycobacterial infection. The diagnosis of cavitating mesenteric lymph node syndrome was made in the clinical setting of celiac disease
Cavitating mesenteric lymphnode syndrome