75-year-old female with history of lymphoma presents with right lower extremity swelling. Ultrasound negative for DVT. Concern for vascular compression by lymphadenopathy. CHEST:LUNGS AND PLEURA: Scattered parenchymal scarring, especially in the apices, remains. Small bilateral pleural effusions are again noted.An AVM (right lower lobar artery to right inferior pulmonary vein) is seen in the right lower lobe (series 3; image 52), unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes remain, unchanged. Reference 8 x 5 mm paratracheal lymph node (series 3; image 22), unchanged.Focal plaque affects the aortic arch, unchanged.CHEST WALL: Several subcentimeter right axillary lymph nodes are seen, not greatly changed.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal sinus cysts are again noted bilaterally. Subcentimeter hypodensities in both kidneys are too small to characterizeRETROPERITONEUM, LYMPH NODES: Numerous mildly enlarged retroperitoneal (periaortic, interaortocaval, paracaval) lymph nodes have developed. For reference, one of the interaortocaval nodes measures 17 x 14 mm (series 3; image 114), previously 8 x 8 mm.BOWEL, MESENTERY: Mild circumferential thickening affects the terminal ileum.BONES, SOFT TISSUES: Patchy bone density is identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged lymph nodes are seen along the common and external iliac chains bilaterally. For reference, a right external iliac lymph node measures approximately 2.4 x 1.5 cm (series 3; image 161), previously approximately 11 x 5 mmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy bone density is identified.OTHER: Narrowing of the right common and right external iliac veins is seen, at least partially due to adjacent adenopathy. Adjacent fat stranding is seen in this region.BILATERAL LOWER EXTREMITIES:The soft tissues of the right thigh are edematous with skin thickening. Lack of venous opacification limits evaluation for thrombosis. However, the caliber of the right lower extremity veins are similar to that of the left lower extremity veins. Varicosities are seen in the right thigh.
Progression of the disease in the form of lymphadenopathy.Narrowing of the right common/external iliac veins secondary to adjacent adenopathy. This is likely the cause of visualized edema affecting the right side.Development of mild wall thickening affecting the terminal ileum. Right lower lobe pulmonary AVM, unchanged.