1. Classical Sandwich Sign In
Mesenteric Lymphoma on
Ultrasound
SHEKHAR KHANPARA
1ST YEAR RESIDENT
MP SHAH MEDICAL COLLEGE
UNDER GUIDANCE OF DR. N.U BAHRI

2. • A 14 year female presented with the complains
of fever and night sweats since 2 months.
• No complain of cough, expectoration, abdominal
pain, weight loss, anorexia, nausea, vomiting,
diarrhea.

3. Ultrasonography
• Multiple conglomerated lymph nodes are noted along portal,
mesentery, para-aortic, paracolic areas. Few of them appear
conglomerated, largest of size (3.2x2.5)cm.
• Few vessels are noted at the center of the conglomerated
lymph node mass situated in paracolic area (arrow).

4. Colour Doppler Study
• On Colour Doppler study, we
can appreciate the blood
vessels coursing through the
center of the conglomerated
lymph node mass, giving rise
to classic “sandwich sign”,
suggestive of possibility of
mesenteric lymphoma.

5. Liver
Liver and spleen appeared enlarged with liver measuring 16 cm and
spleen measuring 13 cm along their respective axis suggestive of
hepatosplenomegaly.
Spleen

6. Spleen
• A heterogeneously
hypoechoic lesion of (1.5x0.6)
cm size is noted in lower pole
of spleen, suggesting
possibility of lymphomatous
infiltration.

7. Blood
investigations
• Hb- 6.4
• RBC-3.09 millions/cumm
• TLC- 11200 with no premature WBC
• PLATELETS-52000
• LDH- 396
• Multiple monotonous cells which have fine
chromatin and lack of nucleoli.
• Possibility of Lymphoblastic Lymphoma likely.
Histopathology

8. Discussion
• Appearance of mesenteric fat and vessels "sandwiched" between
two nodular layers of mesenteric lymphadenopathy.
• Highly suggestive of mesenteric lymphoma
– Usually non-Hodgkin's variety (NHL)
– Mesenteric masses occur in 30-50% of patients with NHL.
• Frequently associated with retroperitoneal adenopathy as well.
• Sandwich sign may also be seen in patients with post-
transplantation lymphoproliferative disorder.

9. Another case of a 12 year old female diagnosed as
lymphoblastic lymphoma.

10. References
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Fundamentals of diagnostic radiology. 2nd ed. Philadelphia, Pa: Williams &
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