CT Findings in Sclerosing Mesenteritis (Panniculitis): Spectrum of Disease

Abstract

Sclerosing mesenteritis is a complex inflammatory disorder of the mesentery. Although sclerosing mesenteritis is often associated with other idiopathic inflammatory disorders such as retroperitoneal fibrosis, sclerosing cholangitis, Riedel thyroiditis, and orbital pseudotumor, its exact cause is unknown. The computed tomographic (CT) appearance of sclerosing mesenteritis will vary depending on the predominant tissue component (fat, inflammation, or fibrosis). CT plays an important role in suggesting the diagnosis in the proper clinical setting and can be useful in distinguishing sclerosing mesenteritis from other mesenteric diseases with similar CT features such as carcinomatosis, carcinoid tumor, lymphoma, desmoid tumor, and mesenteric edema. Nevertheless, surgical biopsy and pathologic analysis are usually necessary to make the diagnosis. Treatment may consist of therapy with steroids, colchicine, immunosuppressive agents, or orally administered progesterone. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited by vascular involvement. CT with three-dimensional volume rendering is optimal for accurate, noninvasive follow-up of sclerosing mesenteritis and of any potential complications.

Occasional finding of mesenteric lipodystrophy during laparoscopy: A difficult diagnosis

“…The biochemistry is mostly unhelpful in diagnosis. CT scan appearance varies from increased attenuation ("misty mesentery") to solid soft-tissue mass, which might envelope the mesenteric vessels preserving a fatty area around ("fat ring sign") [6,7] . Other tumors of the mesentery may show a similar radiologic appearance, like lipoma, lymphoma, carcinoid tumor, carcinomatosis or tubercolosis, mesothelioma, edema or hematoma (from cirrhosis, trauma, hypoalbuminemia, heart failure or vasculitis) [8] .…”

Primary Malignant Fibrous Histiocytoma of the Mesentery: A Case Report

“…The differential diagnoses of soft-tissue masses with ir-regular peritumoral strands in the mesentery include sclerosing mesenteritis, mesenteric edema or hemorrhage, mesenteric inflammation secondary to pancreatitis, fibrofatty mesenteric proliferation related to Crohn's disease, primary mesenteric neoplasms (e.g., a desmoid or carcinoid tumor), peritoneal mesotheliomas, and metastatic neoplasms (5,7). Although rare, a MFH should be included in these differential diagnoses.…”

Sclerosing mesenteritis (panniculitis) mimicking peritoneal tuberculosis

“…However, the absence of adenopathy and the normal appearance of the small bowel wall did not support this diagnosis. Another interesting characteristic of the present case was the history of laparotomy, as well as the smoking habit-both of which are conditions described as pathogenic factors (3). The diagnosis of mesenteric panniculitis should always be considered in a patient with abdominal obstruction and a fatty peritoneal pseudomass on CT (3).…”