Nguyen Trang Truong Hoang, Le Huyen Duy Mai, Vo Duc Tan, Nguyen Duy Thanh, Bui Tien Minh, Vu Thuy Thi
Department of Diagnostic Imaging, University Medical Center, Ho Chi Minh City, Vietnam.
Department of Diagnostic Imaging, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Radiol Case Rep. 2025 Mar 25;20(6):2956-2961. doi: 10.1016/j.radcr.2025.02.107. eCollection 2025 Jun.
A 43-year-old female was admitted with a 1-month history of recurrent periumbilical abdominal pain and nausea. The patient had a 7-year history of Azathioprine use for the management of myasthenia gravis with AChR antibodies. The initial abdominal ultrasound revealed thickened small bowel walls at multiple sites. Abdominal CT enterography (CTE) raised suspicion for Crohn's disease or lymphoma. Upper gastrointestinal endoscopy revealed multiple ulcers in the gastric body and antrum, with biopsy samples taken from the lesions. Histopathological analysis confirmed a diagnosis of B-cell lymphoma in the stomach. However, the imaging characteristics of the small bowel lesions on CTE were inconclusive in distinguishing between Crohn's disease and lymphoma. After a multidisciplinary discussion, the patient was indicated for chemotherapy based on the confirmed diagnosis of gastric lymphoma. While awaiting the scheduled chemotherapy session, the patient developed sudden right iliac fossa pain, which subsequently spread across the abdomen. CT imaging revealed a perforation of the small intestine in the right iliac fossa. The patient underwent surgical resection of the affected small bowel segment, and pathological examination confirmed B-cell lymphoma in the small intestine.
一名43岁女性因反复出现脐周腹痛和恶心1个月入院。该患者有使用硫唑嘌呤治疗伴有乙酰胆碱受体抗体的重症肌无力7年病史。最初的腹部超声显示多个部位的小肠壁增厚。腹部CT小肠造影（CTE）怀疑为克罗恩病或淋巴瘤。上消化道内镜检查发现胃体和胃窦有多个溃疡，并从病变处取了活检样本。组织病理学分析确诊为胃B细胞淋巴瘤。然而，CTE上小肠病变的影像学特征在区分克罗恩病和淋巴瘤方面尚无定论。经过多学科讨论，基于确诊的胃淋巴瘤，该患者被安排进行化疗。在等待预定的化疗疗程期间，患者突然出现右下腹疼痛，随后疼痛蔓延至全腹。CT成像显示右下腹小肠穿孔。患者接受了受累小肠段的手术切除，病理检查证实小肠存在B细胞淋巴瘤。
