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
Fig. 11: Left internal paraduodenal hernia
Fig. 12: Same case as Fig. 11: Left internal paraduodenal hernia
Fig. 13: Internal Herniation
Fig. 14: Malrotation: Case 1.
Fig. 15: Malrotation Case 2.
References: Fleury Medicina Diagnóstica, São Paulo, Brazil
Fig. 16: Malrotation
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
Fig. 24: Mesenteric cyst
References: Fleury Medicina Diagnóstica, São Paulo, Brazil
Fig. 25: Mesenteric cyst
Fig. 26: Hemangiomatosis
References: Diagnósticos da América S.A. DASA. São Paulo, SP, Brazil
Fig. 27: Hemangiomatosis
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
Fig. 40: Abdominal cocoon
Fig. 41: Abdominal cocoon
Secondary Neoplasms
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.
Fig. 44: Lymphomatosis
Fig. 45: Lymphomatosis
Fig. 46: Carcinomatosis
Fig. 47: Carcinomatosis
Fig. 48: Sarcomatosis
Fig. 49: Sarcomatosis
Fig. 50: Peritoneal GIST
Fig. 51: Peritoneal GIST
Fig. 52: Omental cake
Fig. 53: Omental cake
Secondary - Infectious
Fig. 54: Tuberculosis
Fig. 55: Tuberculosis
Fig. 56: Atypical Mycobacteriosis
Fig. 57: Atypical Mycobacteriosis
Fig. 58: Actinomycosis Infection
Fig. 59: Actinomycosis Infection
Fig. 60: Hydatidosis
Fig. 61: Hydatidosis
Secondary - Miscellany
Fig. 62: Splenosis
Fig. 63: Splenosis