A 68 years old male patient presented with recurrent abdominal pain and with a palpable mas

Belo-Oliveira, P

Belo-Soares, P

Peres, P

Teixeira, L

English

Repositório Institucional dos Hospitais da Universidade de Coimbra

 HYPERLINK "http://www.eurorad.org/eurorad/index.php" Mesenteric panniculitisAuthor(s)Belo-Oliveira P, Vaz O, Belo-Soares P, Peres P, Teixeira L  Patientmale, 68 year(s) Clinical Summary A 68 years old male patient presented with recurrent abdominal pain and with a palpable mass. Clinical History and Imaging Procedures A 68 years old male patient presented with recurrent abdominal pain and with a palpable mass. Computed tomography showed the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels. There was preservation of fat around the mesenteric vessels, a phenomenon that is referred to as the "fat ring sign". The diagnosis of mesenteric panniculitis was supported by the imaging findings, absence of pancreatitis and inflammatory bowel disease, and confirmed by histological analysis. Discussion Mesenteric panniculitis is a rare disorder characterized by a chronic nonspecific inflammation involving the adipose tissue of the bowel mesentery. It was first described by Jura in 1924 as sclerosing mesenteritis. In the 1960s, Ogden used the term mesenteric panniculitis to describe this syndrome. Other terms that have been used include retractile mesenteritis, lipogranuloma of the mesentery, isolated lipodystrophy, and retroperitoneal xanthogranuloma. The disease has a 2–3:1 male predilection and is seen more frequently in patients over 50 years old. Children are rarely affected, possibly because they have less mesenteric fat. The cause of this rare disease remains unclear. The disease progresses through three pathologic manifestations: degeneration of mesenteric fat (mesenteric lipodystrophy), inflammatory reaction (mesenteric panniculitis), and fibrosis of the adipose tissue (retractile mesenteritis). The diagnosis of mesenteric panniculitis is supported by the absence of pancreatitis and inflammatory bowel disease. Definitive diagnosis is often made at histologic analysis following laparotomy or laparoscopy. Multiple biopsies are essential for diagnosis, especially with nodular or omental involvement. The differential diagnosis must include the more frequently encountered mesenteric tumours such as lymphoma, lymphosarcoma, and desmoid tumor. Kipfer et al found that 15% of patients with mesenteric panniculitis also had associated malignant lymphoma at follow-up. The CT appearance of sclerosing mesenteritis can vary from subtle increased attenuation in the mesentery to a solid soft-tissue mass. Sclerosing mesenteritis most commonly appears as a soft-tissue mass in the small bowel mesentery, although infiltration of the region of the pancreas or porta hepatis is also possible. The mass may envelop the mesenteric vessels, and, over time, collateral vessels may develop. There may be preservation of fat around the mesenteric vessels, a phenomenon that is referred to as the "fat ring sign". This finding may help distinguish sclerosing mesenteritis from other mesenteric processes such as lymphoma, carcinoid tumor, or carcinomatosis. Calcification may be present, usually in the central necrotic portion of the mass, and may be related to the fat necrosis. Cystic components have also been described and may be the result of lymphatic or venous obstruction as well as necrotic chang. Enlarged mesenteric or retroperitoneal lymph nodes may also be present. Treatment of sclerosing mesenteritis is usually empirical and may consist of therapy with steroids, colchicine, immunosuppressive agents, or orally administered progesterone. Surgical resection is sometimes attempted, but complete removal is often difficult due to vessel compromise and may be of no clear benefit to the patient. In cases of colonic involvement by sclerosing mesenteritis, a colostomy may be necessary because complete surgical resection is often not technically possible. With surgical and medical treatment, some patients will follow a relatively benign course, whereas others will experience progression of the disease, which eventually leads to death. In some cases, the process resolves completely. CT with three-dimensional volume rendering is the optimal study for accurate, non-invasive follow-up of the volume, extent, and vascular involvement of the mass and of any potential complications. Final Diagnosis Mesenteric panniculitis  MeSH1.	Panniculitis, Peritoneal [C06.844.600] Condition of the peritoneum, most commonly of the mesentery, but also of the omentum, characterized by tissue thickening, alteration of fat cells, infiltration of lipid-laden macrophages, and fibrosis. References1.	[1]Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Pickhardt PJ, Bhalla S. Radiographics. 2005 May-Jun;25(3):719-30 (​http:​/​​/​www.ncbi.nlm.nih.gov​/​entrez​/​query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15888621" \t "_blank​) 2.	[2]Mesenteric panniculitis: US and CT features. van Breda Vriesman AC, Schuttevaer HM, Coerkamp EG, Puylaert JB. Eur Radiol. 2004 Dec;14(12):2242-8. Epub 2004 Aug 5 (​http:​/​​/​www.ncbi.nlm.nih.gov​/​entrez​/​query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15300397" \t "_blank​) 3.	[3]CT evaluation of mesenteric panniculitis: prevalence and associated diseases. Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, Gourtsoyiannis N. AJR Am J Roentgenol. 2000 Feb;174(2):427-31. (​http:​/​​/​www.ncbi.nlm.nih.gov​/​entrez​/​query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10658720" \t "_blank​) CitationBelo-Oliveira P, Vaz O, Belo-Soares P, Peres P, Teixeira L (2005, Jun 17).Mesenteric panniculitis, {Online}.URL: http://www.eurorad.org/case.php?id=3858DOI: 10.1594/EURORAD/CASE.3858 (​http:​/​​/​dx.doi.org​/​10.1594​/​EURORAD​/​CASE.3858​) HYPERLINK "javascript:void(0)" To top  	Published 17.06.2005 	DOI 10.1594/EURORAD/CASE.3858 	Section Gastro-Intestinal Imaging (​javascript:search_section(5)​) 	Case-Type Clinical Case (​javascript:search_type(5)​) 	Views 70 	Language(s) 	Figure 1 Abdominal computed tomographyAbdominal computed tomography showing the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels.  	Figure 2 Abdominal computed tomography\"fat ring sign\"- preservation of fat around the mesenteric vessels (arrow)  	Figure 3 Abdominal computed tomographyAbdominal computed tomography showing the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels.  	Figure 4 Abdominal computed tomorgaphyAbdominal computed tomography showing the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels. Figure 1 Abdominal computed tomographyAbdominal computed tomography showing the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels.  Figure 2 Abdominal computed tomography\"fat ring sign\"- preservation of fat around the mesenteric vessels (arrow)  Figure 3 Abdominal computed tomographyAbdominal computed tomography showing the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels.  Figure 4 Abdominal computed tomorgaphyAbdominal computed tomography showing the presence of a subtle increased attenuation of the root of the mesentery, with a mass effect, enveloping mesenteric vessels. To top (​javascript:void(0)​)   Home (​http:​/​​/​www.eurorad.org​/​eurorad​/​index.php​) Search (​http:​/​​/​www.eurorad.org​/​eurorad​/​search.php​) History (​http:​/​​/​www.eurorad.org​/​eurorad​/​history.php​) FAQ (​http:​/​​/​www.eurorad.org​/​eurorad​/​faq.php​) Contact (​http:​/​​/​www.eurorad.org​/​eurorad​/​contact.php​) Disclaimer (​http:​/​​/​www.eurorad.org​/​eurorad​/​disclaimer.php​) Imprint (​http:​/​​/​www.eurorad.org​/​eurorad​/​imprint.php​) 

Mesenteric panniculitis

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Mesenteric panniculitis

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