General Considerations

• Inflammatory process involving adipose tissue of the mesentery
• Usually over the age of 50
• Most cases are idiopathic
• Recent surgery, especially cholecystectomy and appendectomy apparently predispose to its development
  • Also found more often in those with
• Cholelithiasis
• Lymphoma
• Cirrhosis
• Abdominal aortic aneurysm
• Peptic ulcer
• Gastric carcinoma
• Prior abdominal trauma
• Autoimmune disease

Clinical Findings

• Symptoms, when present can be chronic
• Three stages
  • Degeneration of fat (mesenteric lipodystrophy)
• Frequently asymptomatic
• Inflammation (mesenteric panniculitis)
• Poorly defined mass
• Abdominal pain
• Nausea
• Malaise
• Low-grade fever
• Weight loss
• Small bowel obstruction
• Fibrosis (retractile mesenteritis)
• Signs of intestinal obstruction

Imaging Findings

• CT is study of choice
• Absence of pancreatitis, inflammatory bowel disease
• Displacement of bowel loops by a mesenteric “mass”
  • May be well-defined mass or infiltration of mesentery
• Has been described as the misty mesentery sign (see table below)
• Usually in small bowel mesentery
• Usually occurs on the left which is the orientation of the jejunal mesentery
• Strand-like densities surround, but do not displace, the mesentric vessels
• Halo of fat may surround mesenteric vessels
• Well-defined soft tissue nodules usually less than 5 mm
• Usually bowel is not completely obstructed

 

 

 

Differential Diagnosis

• Lymphoma
• Desmoid tumor
• Carcinoid

Treatment

• Benign condition usually requiring no or minimal treatment
  • Steroids have been used
• Rarely recurs

Complications

• Mesenteric panniculitis is rarely documented to progress to fibrosis (retractile mesenteritis)

Prognosis

• Excellent

 

Mesenteric Panniculitis. White arrows point to strand-like infiltration of the small bowel mesentery producing a haziness called the misty mesentery sign. The blood vessels are surrounded but not displaced. There are no enlarged nodes seen.
For more information, click on the link if you see this icon

For this same photo without the annotations, click here

General Case of the Day.  Patel, N; Saleeb, S; Teplick, S. RadioGraphics. 1999;19:1083-1085.) 

CT Evaluation of Mesenteric Panniculitis: Prevalence and Associated Diseases. Daskalogiannaki1, M; Voloudaki1, A; Prassopoulos1, P; Magkanas, E; Stefanaki, K; Apostolaki, E; Gourtsoyiannis. N. AJR 2000; 174:427-431

The misty mesentery on CT: differential diagnosis.  Mindelzun, R; Jeffrey, R; Lane, M; Silverman, M.  Am. J. Roentgenol., Jul 1996; 167: 61 - 65.