A systematic investigation of sclerosing mesenteritis through CT and MRI

Abstract

Sclerosing mesenteritis is primarily diagnosed through histologic and radiologic evaluation; however, only a few works provide a systematic description using MRI. This work presents the case of a 68-year-old male, who was admitted for a routine cholecystectomy. Intraoperativly, a large mass was identified dislocating the abdominal viscera. The microscopic examination revealed vascular congestion of the omentum. The contrast-enhanced CT and MRI scans revealed the presence of a heterogenous, lipomatous mass with lesions visible only in T2W and contrast-enhanced T1W MRI. Based on these findings, the diagnosis of sclerosing mesenteritis was made. According to the available literature, depending on the stage of sclerosing mesenteritis, different radiologic features are encountered; however, it is possible that features from more than one form of the condition coexist in the same lesion. We therefore suggest that a combination of MRI sequences should be acquired for a more accurate staging of the condition.

Sclerosing mesenteritis:an uncommon cause of chronic abdominal pain

“…9,11 CT scan has been useful in diagnosing SM however it is not diagnostic. 23 Owing to the rarity of the cases, the CT findings are described as "Hazy" or "misty" mesentery or unexplained mesenteric mass. 19 The usual CT scan findings are mesenteric lymphadenopathy, fat sparing the mesenteric vessels also known are fat sparing sign, hazy mesenteric fat and separation of mesenteric vessels, increased thickness of the involved mesentery, and well or poorly defined mesenteric mass, pseudo capsule (soft-tissue surrounding the inflamed mass).…”

“…19 The usual CT scan findings are mesenteric lymphadenopathy, fat sparing the mesenteric vessels also known are fat sparing sign, hazy mesenteric fat and separation of mesenteric vessels, increased thickness of the involved mesentery, and well or poorly defined mesenteric mass, pseudo capsule (soft-tissue surrounding the inflamed mass). 4,23 These are usually described as a mass in the mesentery with fat enhancement with multiple soft tissue nodes along the root of the mesentery without vascular compromise. 24 Due to the involvement of the jejunal mesentery, the mass is usually found in the left side.…”

“…24 Due to the involvement of the jejunal mesentery, the mass is usually found in the left side. 23 MRI is not usually performed for the diagnosis of SM, however if done, it is characterized by hyper intense signal in the T2W fat sat indicating edema and intermediate signal density with multiple strands due to fibrotic retraction of the mesentery on T1W signals. When fibrosis is prevalent it manifests as delayed hyper enhancement on T2W images.…”

“…When fibrosis is prevalent it manifests as delayed hyper enhancement on T2W images. 23 On pathology grossly, there is thickening of the mesentery which can be diffuse, single knotty of multiple knotty. 1 Histologically there is a mixture of fat necrosis, chronic inflammation and fibrosis which involve the mesenteric and submucosal fat of the bowel and the mucosa remains intact.…”

Sclerosing mesenteritis mimicking metachronous peritoneal metastases from descending colon adenocarcinoma

“…However, these two CT findings may disappear when mesenteric panniculitis evolves into retractile mesenteritis [ 2 ]. There are some reports indicating the superiority of magnetic resonance imaging (MRI) findings for diagnosing sclerosing mesenteritis [ 15 , 16 ]. If we had performed MRI before laparotomy, the specific MRI findings might be provided.…”