POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information References

ECR 2018 / C-2816

The Mesenteric Organ? - New concepts and a novel radiological perspective on its disease

Congress:

ECR 2018

Poster Number:

C-2816

Type:

Educational Exhibit

Keywords:

Abdomen, MR, CT, Education, Education and training, Mesentery, Peritoneum

Authors:

H. R. F. Dalla Pria¹, F. Velloni¹, R. A. Santiago¹, M. S. Zacarias¹, L. F. D. Silva¹, F. Tamamoto¹, A. C. Von Atzingen², U. S. Torres¹, G. D'Ippolito¹; ¹São Paulo/BR, ²Pouso Alegre/BR

DOI:

10.1594/ecr2018/C-2816

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2816

Table 1: Table of contents

Fig. 11: Left internal paraduodenal hernia

Fig. 12: Same case as Fig. 11: Left internal paraduodenal hernia

Fig. 14: Malrotation: Case 1.

Fig. 15: Malrotation Case 2.

Fig. 17: Sigmoid Volvulus

Fig. 20: Vascular - Mesenteric bleeding/hematoma

Fig. 22: Vascular - Mesenteric ischemia

Fig. 24: Mesenteric cyst

Fig. 26: Hemangiomatosis

Fig. 28: Crohn’s Disease

Fig. 30: Mesothelioma

Fig. 31: Same case as Fig. 30: Mesothelioma

Fig. 33: Desmoplastic Small Round Cell Tumor

Fig. 34: Same case as Fig. 33: Desmoplastic Small Round Cell Tumor

Fig. 36: Sclerosing mesenteritis – mesenteric panniculitis

Fig. 38: Sclerosing mesenteritis – Retractile mesenteritis IgG4 related

Fig. 40: Abdominal cocoon

Fig. 42: Pseudomyxoma

Fig. 44: Lymphomatosis

Fig. 46: Carcinomatosis

Fig. 48: Sarcomatosis

Fig. 50: Peritoneal GIST

Fig. 52: Omental cake

Fig. 54: Tuberculosis

Fig. 56: Atypical Mycobacteriosis

Fig. 58: Actinomycosis Infection

Fig. 60: Hydatidosis

Fig. 62: Splenosis

Fig. 13: Internal Herniation

Fig. 16: Malrotation

Fig. 19: Volvulus

Fig. 21: Vascular - Mesenteric bleeding/hematoma

Fig. 23: Vascular - Mesenteric ischemia

Fig. 25: Mesenteric cyst

Fig. 27: Hemangiomatosis

Fig. 29: Crohn’s Disease

Fig. 32: Peritoneal Malignant Mesothelioma

Fig. 35: Desmoplastic Small Round Cell Tumor

Fig. 37: Sclerosing mesenteritis – mesenteric panniculitis

Fig. 39: Sclerosing mesenteritis – retractile mesenteritis IgG4 related

Fig. 41: Abdominal cocoon

Fig. 43: Pseudomyxoma

Fig. 45: Lymphomatosis

Fig. 47: Carcinomatosis

Fig. 49: Sarcomatosis

Fig. 51: Peritoneal GIST

Fig. 53: Omental cake

Fig. 55: Tuberculosis

Findings and procedure details

Now that we have reviewed the key concepts about the anatomy and radiologic anatomy of the mesentery, we can approach the mesentery pathologies by dividing them into primary and secondary.

Table 1: Table of contents

Primary

Internal Herniation

Fig. 11: Left internal paraduodenal hernia

Fig. 12: Same case as Fig. 11: Left internal paraduodenal hernia

Fig. 13: Internal Herniation

Malrotation

Fig. 14: Malrotation: Case 1.

Fig. 15: Malrotation Case 2.
References: Fleury Medicina Diagnóstica, São Paulo, Brazil

Fig. 16: Malrotation

Volvulus

Fig. 17: Sigmoid Volvulus

Fig. 18: Same case as Fig. 17: Sigmoid Volvulus Video - specific CT sign for volvulus is the whirl sign: vessels twisted like a whirlwind in the center of the bowel twist.

Fig. 19: Volvulus

Vascular - Mesenteric bleeding/hematoma

Fig. 20: Vascular - Mesenteric bleeding/hematoma

Fig. 21: Vascular - Mesenteric bleeding/hematoma

Vascular - Mesenteric ischemia

Fig. 22: Vascular - Mesenteric ischemia

Fig. 23: Vascular - Mesenteric ischemia

Mesenteric cyst

Fig. 24: Mesenteric cyst
References: Fleury Medicina Diagnóstica, São Paulo, Brazil

Fig. 25: Mesenteric cyst

Hemangiomatosis

Fig. 26: Hemangiomatosis
References: Diagnósticos da América S.A. DASA. São Paulo, SP, Brazil

Fig. 27: Hemangiomatosis

Crohn’s Disease

Fig. 28: Crohn’s Disease

Fig. 29: Crohn’s Disease

Primary Neoplasms

Tumors with primary manifestation in the peritoneum in the absence of a visceral site of origin.

They arise from mesothelial cells, submesothelial mesenchymal cells, and uncommitted stem cells .

Because the origins of some primary peritoneal tumors are obscure, these lesions are difficult to classify precisely.

Mesothelial tumors: peritoneal malignant mesothelioma , well-differentiated papillary mesothelioma, multicystic mesothelioma and adenomatoid tumor.

Epithelial tumors: primary peritoneal serous carcinoma and primary peritoneal serous borderline tumor.

Smooth muscle tumor: leiomyomatosis peritonealis disseminata.

Tumors of uncertain origin: desmoplastic small round cell tumor and solitary fibrous tumor.

Peritoneal Malignant Mesothelioma

Fig. 30: Mesothelioma
References: Fleury Medicina Diagnóstica, São Paulo, Brazil

Fig. 31: Same case as Fig. 30: Mesothelioma
References: Fleury Medicina Diagnóstica, São Paulo, Brazil

Fig. 32: Peritoneal Malignant Mesothelioma

Desmoplastic Small Round Cell Tumor

Fig. 33: Desmoplastic Small Round Cell Tumor

Fig. 34: Same case as Fig. 33: Desmoplastic Small Round Cell Tumor

Fig. 35: Desmoplastic Small Round Cell Tumor

Primary- Inflammatory

Sclerosing mesenteritis - mesenteric panniculitis

Fig. 36: Sclerosing mesenteritis – mesenteric panniculitis

Fig. 37: Sclerosing mesenteritis – mesenteric panniculitis

Sclerosing mesenteritis – retractile mesenteritis IgG4 related

Fig. 38: Sclerosing mesenteritis – Retractile mesenteritis IgG4 related

Fig. 39: Sclerosing mesenteritis – retractile mesenteritis IgG4 related

Abdominal cocoon

Fig. 40: Abdominal cocoon

Fig. 41: Abdominal cocoon

Secondary Neoplasms

Pseudomyxoma

Fig. 42: Pseudomyxoma

Fig. 43: Pseudomyxoma

Lymphomatosis x Carcinomatosis x Sarcomatosis

Conditions with overlapping characteristics:

Carcinomatosis: Peritoneal and omental seeding are known sites of dissemination of metastatic carcinoma, most commonly arising from the ovary, colon and stomach. Lymphadenopathy is usually located around the primary tumor. Ascites is usually marked.

Lymphomatosis: omental caking with homogeneous bulky masses, in addition to a diffuse distribution of enlarged lymph nodes.

Sarcomatosis: may present bulky masses, but they are frequently heterogeneous, hypervascular and may be associated with hemoperitoneum. Lymphnode enlargement is rare.