1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Paul J Cunningham Affiliation: Madigan Army Medical Center

2. MedPix No: 2523 - History Pt Demographics: Age = 45 y.o. Gender = man A 43-year-old white man presented with a 4 month history of right lower quadrant pain, abdominal distention, and a 25 pound weight loss over the last month. Downloaded by (-1)

3. MedPix No: 2523 - EXAM & LABS Remarkable for a mobile 8-cm right lower quadrant mass.

4. Contrast-enhanced CT of the abdomen Marked thickening of the wall of the cecum, a narrowed lumen, vague regions of low density within the wall, and stranding in the pericecal fat. More inferior images show thickening of the inferior tip of the cecum and nodular stranding of the pericecal fat extending to the lateroconal fascia, which is thickened. Downloaded by (-1)

5. Contrast-enhanced CT of the abdomen Marked thickening of the wall of the cecum, a narrowed lumen, vague regions of low density within the wall, and stranding in the pericecal fat. More inferior images show thickening of the inferior tip of the cecum and nodular stranding of the pericecal fat extending to the lateroconal fascia, which is thickened. Downloaded by (-1)

6. Contrast-enhanced CT of the abdomen Marked thickening of the wall of the cecum, a narrowed lumen, vague regions of low density within the wall, and stranding in the pericecal fat. More inferior images show thickening of the inferior tip of the cecum and nodular stranding of the pericecal fat extending to the lateroconal fascia, which is thickened. Downloaded by (-1)

7. CT of the chest Parenchymal nodules along the bronchovascular bundles, nodular thickening of the interlobular septa, and small subpleural nodules. Downloaded by (-1)

8. CT of the chest Parenchymal nodules along the bronchovascular bundles, nodular thickening of the interlobular septa, and small subpleural nodules. Downloaded by (-1)

9. FINDINGS Cecal mass (wall thickening)Mesenteric thickeningPulmonary interstitial disease

10. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

11. Diagnosis: Sarcoidosis of the Cecum Dx Confirmed by:

12. DISCUSSION