Case of the week 9.12.22
Publication Date: 2022-09-12
3 images
Findings
Orthogonal radiographs of the abdomen are available for interpretation.
There is moderate loss of serosal detail in the cranial ventral aspect of the abdomen with associated soft tissue/fluid streaking.
Visible on all the projections, there is severe thickening of the gastric wall diffusely. The gastric wall measures up to at least 1.5 cm in thickness.
Bilaterally there is mild to moderate remodeling of the renal margins with irregular margination and some flattening.
The remainder of the abdomen is otherwise unremarkable.
Diagnosis
Severe gastric wall thickening. Primary consideration is given to diffuse neoplastic infiltrative process such as lymphoma. Less likely severe gastritis cannot be ruled out.
Renal remodeling bilaterally could be indicative of chronic renal disease graded as mild to moderate. However underlying neoplastic infiltration cannot be totally excluded. Free fluid in the cranial abdomen could be reactive in nature; however, neoplastic effusion cannot be excluded.
Discussion
Thoracic radiographs were unremarkable.
The patient underwent abdominal ultrasound and gastric FNAs. Cytology was consistent with high-grade lymphoma.
On the majority of radiographs, measuring the gastrointestinal wall thickness is highly unreliable. However, there are certain cases like this one where an accurate assessment can be established.
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