Hyperechoic mesenteric lymphnodes, weight loss and abdominal pain

A 40 years old male was admitted for weight loss of 5 kilograms and abdominal pain. Diarrhea was denied. He had no further history of diseases. He reported a cigarrette consumption of about 25 pack years. At physical examination we found slight tenderness of the abdomen, no other pathological findings. His general pracitioner had already arranged a CT-scan of the thorax, which showed enlarged mediastinal and retroperitoneal lymphnodes without tumor growth in thorax and abdomen. The patient was sent for ultrasound guided puncture of the abdominal lymphnodes to our ultrasound laboratory. We found the lymphnodes be…