Gastrointestinal - CT Protocols - CTisus.com CT Scanning

Gastrointestinal ❯ R/O Lymphoma in the Abdomen

Problem

CT Protocol-Rule out lymphoma in the abdomen

Protocol

The standard protocol for evaluation of suspected lymphoma requires both oral and IV contrast and is done as a single phase venous acquisition at about 70 seconds post injection of IV contrast. Typically, positive oral contrast (750-1000 cc of Ioxehol-350 diluted) is given 45-60 minutes prior to the study with the last 250 cc at the time of the study to distend the stomach. Water can be used as an alternative agent.

Pearls

Lymphoma can involve any organ or organ system so a careful review of the study is necessary. Some considerations are;

Gastric lymphoma is usually bulkier than gastric adenocarcinoma and nodes are more extensive and extend beneath the renal hilum
Primary adrenal lymphoma usually is bilateral with large triangle shaped adrenals
Renal lymphoma has many presentations form solitary to multiple masses as well as diffuse infiltration and involvement of the perirenal space. Renal lymphoma can simulate a primary carcinoma
Small bowel involvement can be subtle with focal infiltration or can present with ulcerating tumor. Small bowel lymphoma can also present with an intussusception
Adenopathy can involve any chain including the mesentery
In most cases a chest CT will also be needed for staging
A tumor that extends from the terminal ileum into the cecum is more likely lymphoma than adenocarcinoma