Epigastric lymphadenopathy was present and significantly enlarged with loss of structural detail as well. A large amount of reactive omentum was noted around the upper gastrointestinal tract and pancreas. The mid to distal small intestine was unremarkable. The liver presented increased portal markings and thickened gallbladder with some nodular changes primarily in the region of the porta hepatis and right medial liver. The hepatic veins were not dilated. A moderate amount of abdominal free fluid was noted, which was echogenic. A large amount of pleural effusion , echogenic, was also noted with variable areas of lung consolidation. A thickened myocardium was noted. The contractility appeared adequate. Upper gastrointestinal infiltrative pattern with pleural effusion and ascites. Aggressive upper gastrointestinal mesenteric root lymphadenopathy.