SMA syndrome

18 years old female with vomiting and upper abdominal pains. Patient has mass lesion at distal 3rd part of duodenum mainly infiltrating mesentery. Pathology of the large mass showed inflammatory lymphadenopathy. The constriction in mid portion of 3rd part of duodenum may be due to decreased angle between SMA and aorta. Other explanation is lymphatic infiltrations of duodenal wall at this narrow point. Note distended stomach and duodenal cap.