This exhibit describes a 51 year old male patient with celiac disease who was referred because of a non-tender abdominal mass. A complex cystic-appearing lobulated mass with somewhat echogenic walls most consistent with calcifications was seen on ultrasound (US) imaging. Subsequent plain film x-ray of the abdomen revealed fine curvilinear calcifications in the left lower quadrant. Color Doppler imaging showed no evidence of vascularity within the lesion. CT imaging showed thin rinds of calcification in the walls of multiple cystic components. MR imaging confirmed the presence of fat within the anterior portion of the lesion. A CT guided biopsy was conducted. The fine-needle aspirate revealed calcified material with no associated cellular material. No malignant cells were seen. At this time cavitating mesenteric lymph node syndrome (CMNLS) was established as the diagnosis. Only 37 cases of CMLNS have been reported globally to-date. We are not aware of any previous reports in the literature describing the finding of rim calcification on US in the setting of CMLNS. CMLNS is an important diagnosis to consider, particularly in patients with a history of celiac disease. The finding of rim calcification on ultrasound in the setting of cavitating mesenteric adenopathy should prompt further diagnostic imaging studies such as CT or MR. These may lead to additional pathology studies such as a CT guided biopsy to further characterize the lesion at a cellular level in order to investigate potential malignancy and to guide further follow up and patient management.