Learning objectives
The aim of this educational exhibit is to identify specific imaging characteristics of various pathologic entities which may cause an increase in attenuation of mesenteric fat in order to provide a rational approach to differential diagnosis.
Special focus will be put on better understanding imaging characteristics of sclerosing mesenteritis as an idiopathic still not entirely explained primary disease of the mesentery
Background
Mesentery represents double layer of peritoneum that encloses an organ and connects it to the posterior abdominal wall.
The fundamental histological elements of the mesentery are the surface mesothelium and the core made of adipocyte containing loose connective tissue which provides a lattice to lymph nodes,
blood vessels and nerves passing to and from viscera.
(1)
Traditionally,
mesentery was thought to consist of three parts: small bowel mesentery,
transverse and sigmoid mesocolon.
However,
novel findings imply that the mesentery distal to the duodenojejunal flexure is...
Findings and procedure details
Sclerosing mesenteritis (SM)
Sclerosing mesenteritis is a rare condition characterized by pathologic processes of chronic inflammation (panniculitis),
necrosis (lipodystrophy) and fibrosis (scarring-retraction) of the adipose component of the intestinal mesentery.
(5) The prevalence ranges from 0.6% to 2.5 % (6) and cases are usually male (3:1) and older than 50 years of age,
although younger cases have been reported.
The disease can be asymptomatic when it is usually discovered as an incidental finding or can be related to unspecific symptoms such as abdominal pain,
nausea...
Conclusion
Diagnosis of “misty mesentery” on CT should motivate a radiologist to consider a broad range of pathologic conditions that may cause an increase in attenuation of mesenteric fat.
Radiologists should be aware of characteristic signs of sclerosing mesenteritis on CT because such diagnosis should encourage a thorough clinical examination as it may be relevant in terms of clinical predictability of an associated neoplasm and should not be disregarded.
Large studies are necessary to determine correlation between SM and neoplasms and to compare distinctive features of...
References
1. Coffey JC et al.
The mesentery: structure,
function,
and role in disease.
Lancet Gastroenterol Hepatol.
2016; 1(3):238–47.
2. Mindelzun RE et al. The “misty mesentery” on CT: differential diagnosis. American Journal of Roentgenology1996167:1,61-65
3. Filippone,
A.
et al.
“Misty mesentery”: a pictorial review of multidetector-row CT findings.
Radiol med (2011) 116: 351.
4. Federle M.,
Raman S.
(2015) Diagnostic imaging.
Gastrointestinal.
Retrived from https://www.elsevier.com/books
5. Akram,
Salma et al.
Sclerosing Mesenteritis: Clinical Features,
Treatment,
and Outcome in Ninety-Two Patient.
Clinical Gastroenterology and Hepatology ,...