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prostanoids are among the first agents used to treat pulmonary hypertension and are currently

considered the most effective. This case study describes a 63-year-old man who was
diagnosed with chronic thromboembolic pulmonary hypertension and successfully treated with
subcutaneously administered treprostenil for 6 months before a successful pulmonary

thromboendarterectomy. Treatment of chronic thromboembolic pulmonary hypertension often

requires a multidisciplinary approach before surgery. Further evaluation of prostanoids is
needed to define their role and time of initiation of medical therapy in these patients.

14. Oikonomou A, Michailidou E, Deftereos S, Karanikas M, Spanoudakis E, Prasssopoulos P.
Synchronous small bowel lymphoma and hepatocellular carcinoma.

URL:http://www.euroradorg/case.php?id=9151 DOI: 10.1594/EURORAD/CASE.9151

Abstract: CLINICAL HISTORY: A 79-year-old man presented at the emergency department with

vague abdominal pain and anaemia (Ht: 28, Hb: 9.1). The patient reported fever (38° C) for the
past three days before admission.

IMAGING FINDINGS: A 79-year-old man presented at the emergency department with vague
abdominal pain in the right iliac fossa and aneamia. The patient reported fever (38° C) for the

past three days before admission. He was positive for surface antigen of hepatitis B and had
known sigmoid diverticulosis. CT of the abdomen revealed a homogeneous wall thickening of

a segment of the ileum with moderately enlarged lymph nodes in the mesentery and in the
bifurcation of the left common iliac vein (Fig. 1, 2). Further, a mass was present in the hepatic

dome with peripheral enhancement in the portal-venous phase, consistent with neoplastic
disease (Fig. 3). Patient was operated and histology was consistent with diffuse large B cell

non-Hodgkin lymphoma (NHL). Ultrasound-guided biopsy of the hepatic lesion revealed
hepatocellular carcinoma (HCC). Patient was started on 4 cycles of R-CHOP (Rituximab -

Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) chemotherapy for NHL and
somatostatin for HCC.

DISCUSSION: The rule in medicine is to try to interpret imaging and clinical findings under the

umbrella of one main disease. However, synchronous coexistence of two different pathologies
in a patient should be kept in mind and appropriate further action should be taken in order not

to miss a diagnosis of a second primary disease. NHL is the third most common small bowel
malignancy – following adenocarcinoma and neuroendocrine tumour – and represents 10-15%

of malignant small bowel tumours. It typically affects the ileum and may present either as
primary lymphoma arising from the mucosa associated lymphoid tissue (MALT) or as part of
systemic lymphatic disease [1]. It may also occur secondary to coeliac disease. Clinical

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