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Jang S, Lee S, Choi J. CT imaging features of fat stranding in cats and dogs with abdominal disorder. J Vet Sci 2022; 23:e70. [PMID: 36038190 PMCID: PMC9715384 DOI: 10.4142/jvs.22059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fat stranding is a non-specific finding of an increased fat attenuation on computed tomography (CT) images. Fat stranding is used for detecting the underlying lesion in humans. OBJECTIVES To assess the clinical significance of fat stranding on CT images for identifying the underlying cause in dogs and cats. METHODS In this retrospective study, the incidence, location, extent, distribution, and pattern of fat stranding were assessed on CT studies obtained from 134 cases. RESULTS Fat stranding was found in 38% (51/134) of all cases and in 35% (37/107) of tumors, which was significantly higher in malignant tumors (44%) than benign tumors (12%). Moreover, fat stranding was found in more than two areas in malignant tumors (16/33) and in a single area in benign tumors (4/4). In inflammation, fat stranding was demonstrated in 54% (7/13) in a single area (7/7) as a focal distribution (6/7). In trauma, fat stranding was revealed in 50% (7/14) and most were in multiple areas (6/7). Regardless of the etiologies, fat stranding was always around the underlying lesion and a reticular pattern was the most common presentation. Logistic regression analysis revealed that multiple areas (p = 0.040) of fat stranding and a reticulonodular pattern (p = 0.022) are the significant predictors of malignant tumor. CONCLUSIONS These findings indicated that CT fat stranding can be used as a clue for identifying the underlying lesion and can be useful for narrowing the differential list based on the extent and pattern.
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Affiliation(s)
- Seolyn Jang
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Suhyun Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
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O'Regan PW, Mhuircheartaigh JMN, Scanlon TG, Shelly MJ. Radiology of the Mesentery. Clin Colon Rectal Surg 2022; 35:328-337. [PMID: 35975110 PMCID: PMC9376046 DOI: 10.1055/s-0042-1744481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The recent description and re-classification of the mesentery as an organ prompted renewed interest in its role in physiological and pathological processes. With an improved understanding of its anatomy, accurately and reliably assessing the mesentery with non-invasive radiological investigation becomes more feasible. Multi-detector computed tomography is the main radiological modality employed to assess the mesentery due to its speed, widespread availability, and diagnostic accuracy. Pathologies affecting the mesentery can be classified as primary or secondary mesenteropathies. Primary mesenteropathies originate in the mesentery and subsequently progress to involve other organ systems (e.g., mesenteric ischemia or mesenteric volvulus). Secondary mesenteropathies describe disease processes that originate elsewhere and progress to involve the mesentery with varying degrees of severity (e.g., lymphoma). The implementation of standardized radiological imaging protocols, nomenclature, and reporting format with regard to the mesentery will be essential in improving the assessment of mesenteric anatomy and various mesenteropathies. In this article, we describe and illustrate the current state of art in respect of the radiological assessment of the mesentery.
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Affiliation(s)
- Patrick W. O'Regan
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
| | - Jennifer M. Ní Mhuircheartaigh
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Timothy G. Scanlon
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Martin J. Shelly
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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3
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Lei YL. Value of superior-mesenteric-artery-diameter/superiormesenteric-vein-diameter on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection. World J Emerg Med 2022; 13:202-207. [DOI: 10.5847/wjem.j.1920-8642.2022.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
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Gunes SO, Akturk Y, Guldogan ES, Yilmaz KB, Ergun O, Hekimoglu B. Association between mesenteric panniculitis and non-neoplastic disorders. Clin Imaging 2021; 79:219-224. [PMID: 34119913 DOI: 10.1016/j.clinimag.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relationship between MP and coexisting non-neoplastic disorders. METHODS Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann-Whitney U, χ2, or Fisher's test. RESULTS 976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064-0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012-0.036). CONCLUSION MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.
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Affiliation(s)
- Serra Ozbal Gunes
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey.
| | - Yeliz Akturk
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Esra Soyer Guldogan
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Kerim Bora Yilmaz
- Department of General Surgery, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Onur Ergun
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Baki Hekimoglu
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
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Gopireddy DR, Soule E, Arif-Tiwari H, Sharma S, Kanmaniraja D, Jain K, Letter H, Lall C. Spectrum of CT Findings Related to Bowel Adhesions Without Bowel Obstruction: A Comprehensive Imaging Review. J Clin Imaging Sci 2020; 10:80. [PMID: 33365202 PMCID: PMC7749936 DOI: 10.25259/jcis_126_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022] Open
Abstract
Post-operative adhesions can occur following abdominal or pelvic surgery and are a significant cause of morbidity and mortality. Adhesions are an important cause of abdominal complaints, especially chronic abdominal pain, infertility, and bowel obstruction; responsible for an estimated $2.3 billion annual burden in the United States alone. There is a paucity of literature describing CT findings indicative of the presence of adhesions, however, findings suggestive of this entity may be discovered by a discerning eye. Early recognition and diagnosis may be beneficial for reducing consumption of health-care resources related to abdominal complaints. In addition, these findings may impact surgical planning and facilitate recognition of adhesion-related complications, said to be responsible for a significant number of malpractice claims. The following review discusses various CT findings which may indicate the presence of adhesions. These findings may initially be overlooked, but remain valuable as the clinical presentation evolves to become consistent with adhesive disease. Detection of bowel and peritoneal adhesions can be recognized on imaging modalities based on distortion of bowel loops. This pictorial review illustrates the spectrum of findings related to bowel adhesions encountered on computed tomography imaging.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Erik Soule
- Department of Interventional Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Smita Sharma
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Devaraju Kanmaniraja
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Kapila Jain
- Department of Radiology, East and North Hertfordshire NHS Trust, Coreys Mill Lane, United Kingdom
| | - Haley Letter
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
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Ahmed SA, Abou-Taleb H, Yehia A, El Malek NAA, Siefeldein GS, Badary DM, Jabir MA. The accuracy of multi-detector computed tomography and laparoscopy in the prediction of peritoneal carcinomatosis index score in primary ovarian cancer. Acad Radiol 2019; 26:1650-1658. [PMID: 31101436 DOI: 10.1016/j.acra.2019.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed. METHODS This prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics. RESULTS Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients. CONCLUSION Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.
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Affiliation(s)
| | - Hisham Abou-Taleb
- Department Obstetrics & Gynecology, Women Health Hospital, Assiut University, Assiut, Egypt
| | - Ahmed Yehia
- Department Obstetrics & Gynecology, Women Health Hospital, Assiut University, Assiut, Egypt
| | | | | | - Dalia M Badary
- Department of pathology, Assiut university hospital, Egypt
| | - Murad Aly Jabir
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University
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Karami M, Taki M. Prevalence of lymph node and maximum short axis in traumatic patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:1. [PMID: 29456558 PMCID: PMC5813295 DOI: 10.4103/jrms.jrms_434_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/19/2017] [Accepted: 10/08/2017] [Indexed: 11/06/2022]
Abstract
Background: Normal size of mesenteric lymph nodes has not been well evaluated, as these lymph nodes are small but may be seen frequently in computed tomography (CT). The aim of this study is to determine the prevalence of mesenteric lymph nodes at root of mesentery and mesentery itself. Materials and Methods: This is a cross-sectional study on traumatic patients with normal multidetector CT (MDCT) referred to Al-Zahra Hospital in 2014–2016. The largest short axis of lymph nodes was recorded. Their location was divided into three groups of mesenteric root, peripheral mesentery, and mesentery of the right lower quadrant (RLQ). Size and number of lymph nodes in terms of locations were recorded. A number of more than 6 nodes in a position was defined as cluster nodes. Data were analyzed using SPSS software version 20. P < 0.05 was considered statistically significant. Results: Four hundred traumatic patients underwent MDCT scanning. The mean age of these patients was 36.6 ± 13.4 years. The number of lymph nodes was <3 in 49.3%, 52.5%, and 52.2%; 3–6 in 45.8%, 42.8%, and 42.8%; >6 in 5%, 4.8%, and 4.8% of central, peripheral, and RLQ mesentery, respectively. The average size of largest central, peripheral, and RLQ lymph nodes was 4.53 ± 1.33, 4.37 ± 1.68, and 4.37 ± 1.68, respectively (P = 0.64). Largest size of short axis in patients with cluster lymph nodes was significantly more than noncluster nodes (P < 0.001 for all regions). Conclusion: Mean size of mesenteric lymph nodes was similar to the previous study, but the largest nodes were considerably larger. Furthermore, largest short axis of cluster nodes was significantly more than noncluster ones.
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Affiliation(s)
- Mehdi Karami
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Taki
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Marcus SG, Candia S, Kohli MD, Mongan J, Zagoria RJ, Behr SC, Sun D, Westphalen AC. Association between misty mesentery with baseline or new diagnosis of cancer: a matched cohort study. Clin Imaging 2017; 50:57-61. [PMID: 29276962 DOI: 10.1016/j.clinimag.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/27/2022]
Abstract
We compared the prevalence of a baseline diagnosis of cancer in patients with and without misty mesentery (MM) and determined its association with the development of a new cancer. This was a retrospective, HIPAA-compliant, IRB-approved case-control study of 148 cases and 4:1 age- and gender-matched controls. Statistical tests included chi-square, t-test, hazard models, and C-statistic. Patients with MM were less likely to have cancer at baseline (RR=0.74, p=0.003), but more likely to develop a new malignancy on follow-up (RR=2.13, p=0.003; survival analysis HR 1.74, p=0.05). MM may confer an increased probability of later developing cancer, particularly genitourinary tumors.
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Affiliation(s)
- Sivan G Marcus
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - Susana Candia
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - Marc D Kohli
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - John Mongan
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - Ronald J Zagoria
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - Spencer C Behr
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - Derek Sun
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
| | - Antonio C Westphalen
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-372, San Francisco, CA 94143, United States.
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Mesenteric panniculitis: systematic review of cross-sectional imaging findings and risk of subsequent malignancy. Eur Radiol 2016; 26:4531-4537. [PMID: 27048526 PMCID: PMC5101267 DOI: 10.1007/s00330-016-4298-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/17/2022]
Abstract
Objectives Systematic review to determine any association between imaging features of idiopathic mesenteric panniculitis (MP) and subsequent malignancy. Methods Two researchers searched primary literature independently for imaging studies of MP. They extracted data focusing on methodology for unbiased patient accrual and capability to determine a link between MP and subsequent malignancy. They noted imaging features of MP. Data were accrued and meta-analysis intended. Results Fourteen of 675 articles were eligible; 1,226 patients. Only three (21 %) accrued patients prospectively. Twelve (86 %) studies described CT features. Follow-up varied widely; 1 month to 8 years. Prevalence of MP was influenced by accrual: 0.2 % for keyword search versus 1.7 % for consecutive series. Accrual bias affected nine (64 %) studies. 458 (38 %) of 1,209 patients had malignancy at accrual but varied widely (8–89 %), preventing meta-analysis. Sixty (6.4 %) of 933 patients developed new malignancy subsequently, also varying widely (0–11 %). Of just four studies that determined the proportion of unselected, consecutive patients with MP developing subsequent malignancy, three were retrospective and the fourth excluded patients with lymphadenopathy, likely excluding patients with MP. Conclusion Studies were heterogeneous, with biased accrual. No available study can determine an association between MP and subsequent malignancy with certainty. Key Points • Our systematic review of mesenteric panniculitis found that imaging studies were biased. • Spectrum and recruitment bias was largely due to retrospective study designs. • No study could confirm a certain link between mesenteric panniculitis and subsequent malignancy. • Excessive methodological heterogeneity precluded meaningful meta-analysis. • High-quality research linking mesenteric panniculitis imaging features and subsequent malignancy is needed.
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Taffel MT, Khati NJ, Hai N, Yaghmai V, Nikolaidis P. De-misty-fying the mesentery: an algorithmic approach to neoplastic and non-neoplastic mesenteric abnormalities. ACTA ACUST UNITED AC 2016; 39:892-907. [PMID: 24633598 DOI: 10.1007/s00261-014-0113-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mesenteric abnormalities are often incidentally discovered on cross-sectional imaging performed during daily clinical practice. Findings can range from the vague "misty mesentery" to solid masses, and the possible etiologic causes encompass a wide spectrum of underlying pathologies including infectious, inflammatory, and neoplastic processes. Unfortunately, the clinical and imaging findings are often non-specific and may overlap. This article discusses the various diseases that result in mesenteric abnormalities. It provides a framework to non-invasively differentiate these entities, when possible.
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Affiliation(s)
- Myles T Taffel
- Department of Radiology, The George Washington University Hospital, 900 23rd St, NW, Washington, DC, 20037, USA,
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Does the Degree of Perihepatitis Have Any Relevance to the Severity of the Manifestations of Pelvic Inflammatory Disease on Multidetector Computed Tomography? J Comput Assist Tomogr 2016; 39:901-6. [PMID: 26248151 DOI: 10.1097/rct.0000000000000291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to evaluate the relationship between the degree of perihepatitis and the severity of pelvic inflammatory disease (PID) on multidetector computed tomography (MDCT). METHODS A total of 177 women with PID who underwent biphasic abdominal computed tomography (CT) scans were enrolled. Two reviewers retrospectively reviewed the CT scans with consensus and subjectively categorized the severity of PID into 4 grades (normal, mild, moderate, and severe). Another reviewer independently assigned the extent (grades 0 to 4) and the depth (grades 0 to 4) of hepatic surface enhancement in terms of the degree of perihepatitis. Relationships between the degree of perihepatitis and the CT severity as well as each CT manifestation of PID were evaluated using the χ test or a cumulative logistic regression analysis. RESULTS Of the 177 patients, 99 (55.9%) showed hepatic surface enhancement. The severity of PID on MDCT was significantly related with the degree of perihepatitis (all P < 0.001). Salpingitis, oophoritis, pelvic fat haziness, complicated ascites, and omental/mesenteric fat infiltration were significantly related with the degree of perihepatitis (all P < 0.05). Among these variables, omental/mesenteric fat infiltration (odds ratio = 10.9) and salpingitis (odds ratio = 6.0) were the CT manifestations that were most associated with the presence of perihepatitis in PID. CONCLUSIONS The degree of perihepatitis seems to show a relationship with the severity of PID on MDCT. Omental/mesenteric fat infiltration and salpingitis can be strongly related with perihepatitis in PID.
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Abstract
In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as 'retractile mesenteritis.' It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.
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van Putte-Katier N, van Bommel EFH, Elgersma OE, Hendriksz TR. Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up. Br J Radiol 2014; 87:20140451. [PMID: 25271412 DOI: 10.1259/bjr.20140451] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine prevalence, clinicoradiological characteristics and outcome of patients with mesenteric panniculitis (MP) in a large hospital-based population. METHODS Consecutive abdominal CT examinations of 3820 patients were evaluated for MP. Clinical characteristics, therapy and outcome of patients with MP were evaluated during a 5-year follow-up period. A matched pair analysis was performed to further investigate the relation between MP and malignancy. RESULTS 94 (2.5%) patients with MP were identified (mean age, 66.6 ± 11.2 years, 70.2% male). MP coexisted with malignancy (especially prostatic carcinoma) in 48.9% of patients, and this was slightly but significantly higher than in age- and sex-matched control patients (n = 188, 46.3%). In 48 patients, MP was presumed to be idiopathic. The most frequent presenting symptom was pain (54.3%). Laboratory findings revealed increased acute-phase reactants in half of the patients with MP. CT findings included increased density of mesenterial fat (mean, -56.8 ± 10.8 HU), fat ring sign, tumoural pseudocapsule and small soft-tissue nodules. Patients with MP (14.6%) developed significantly more malignancies during a 5-year follow-up than did the control group (6.9%). One patient was treated with prednisone without satisfactory response. CONCLUSION The prevalence of MP in this study was 2.5%. In most patients, radiologic features included increased mesenteric fat density, fat ring sign and small soft-tissue nodules. MP was associated with a significant higher prevalence of coexisting malignancies and a higher prevalence of future cancer development. ADVANCES IN KNOWLEDGE A more accurate prevalence of MP on CT is demonstrated. An underlying malignancy may play a role.
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Segmental "misty mesentery" on FDG PET/CT: an uncommon manifestation of mesenteric lymphoma. Clin Nucl Med 2014; 39:84-6. [PMID: 23797224 DOI: 10.1097/rlu.0b013e31829960f6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mesenteric lymphomas are commonly seen as bulky hypermetabolic nodal masses on F-FDG PET/CT. Very rarely, these are seen as mesenteric haziness due to localized hyperattenuation of fat, known as "misty mesentery", which morphological imaging-wise has other differentials as well. We report a unique imaging finding of segmental misty mesentery with hypermetabolic mesenteric nodes on FDG PET/CT in a patient who was kept on observation due to inconclusive biopsy, which on follow-up imaging progressed to extensive lymphomatous involvement. Thus, in retrospect, this imaging feature on baseline PET/CT was diagnostic for mesenteric lymphoma.
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Nakatani K, Nakamoto Y, Togashi K. FDG-PET/CT assessment of misty mesentery: Feasibility for distinguishing viable mesenteric malignancy from stable conditions. Eur J Radiol 2013; 82:e380-5. [DOI: 10.1016/j.ejrad.2013.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/15/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
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Relationship between mesenteric abnormalities on computed tomography and malignancy: clinical findings and outcomes of 359 patients. J Clin Gastroenterol 2013. [PMID: 23188076 DOI: 10.1097/mcg.0b013e3182703148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mesenteric abnormalities are detected on abdominal computed tomography (CT) performed for various indications. GOALS Determine the risk of malignancy on follow-up of patients with these abnormalities without a preexisting malignancy. STUDY Data were collected on all patients at NorthShore University HealthSystem with abdominal CT scan reports of mesenteric abnormalities labeled as "panniculitis" from January 2005 to April 2010. RESULTS Three hundred fifty-nine patients were identified, 81 (22.6%) had a known malignancy at the time of the index abdominal CT scan. Nineteen (6.8%) of the 278 had a new diagnosis of malignancy on evaluation of the findings of the index CT scan. Among the 240 (86.33%) that did not have a notation of the abnormality in their medical record, 11 (4.58%) developed a malignancy during the study period. Sixty-eight of the 248 (24.46%) without a known malignancy had diseases associated with mesenteric abnormalities. The presence of these were associated with a reduction in the likelihood that the abnormalities are associated with new or delayed diagnosis of a malignancy (odds ratio, 0.197; 95% confidence interval, 0.0045-0.8501; P=0.013). Progression of underlying malignancy was unlikely in those where the mesenteric abnormalities did not worsen in appearance on follow-up CT scans (odds ratio, 0.03268; 95% confidence interval, 0.0028-0.3761; P=0.0061). CONCLUSIONS In the presence of an underlying disease associated with these findings, the subsequent finding of a malignancy is less likely. In addition, neglect of these findings may result in delayed diagnosis of cancer.
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Guettrot-Imbert G, Boyer L, Piette JC, Delèvaux I, André M, Aumaître O. [Mesenteric panniculitis]. Rev Med Interne 2012; 33:621-7. [PMID: 22658529 DOI: 10.1016/j.revmed.2012.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/15/2012] [Indexed: 12/17/2022]
Abstract
Mesenteric panniculitis is a nonspecific inflammatory process affecting the fatty tissue at the root of the mesentery. This term is also used to describe the clinical and imaging findings in this disorder. Mesenteric panniculitis can be a misleading term: it is commonly misused to design an increased density of the mesentery without prejudice regarding the etiology. Pain is the main clinical symptom. Half of the patients are asymptomatic. There is a palpable mass in half of cases. Laboratory tests sometimes reveal an acute phase reaction of varying intensity. Mesenteric panniculitis is suspected when CT scan shows increased density of the mesenteric fat. Nevertheless, only histological examination could establish the diagnosis. Histologic examination may reveal various stages: lipodystrophy (the first stage when fat necrosis is predominant), mesenteric panniculitis (a majority of infiltrating lymphocytes), sclerosing mesenteritis (the end stage when fibrosis is predominant). Histopathologic differential diagnoses are lymphomas, lipomas, liposarcomas that can mimic mesenteric panniculitis on CT scan. Mesenteric panniculitis is associated with various diseases, especially with intra-abdominal inflammatory process. It also can be idiopathic. Rare complications can occur with vascular or digestive tract compressions. Empirical treatment is only useful in symptomatic patients. Colchicine, corticosteroids or immunosuppressive agents can be used. The only interest of surgery is the histological confirmation of the diagnosis. A better understanding of the pathophysiology of the immunoregulatory functions of adipose tissue will improve mesenteric panniculitis management.
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Affiliation(s)
- G Guettrot-Imbert
- Service de médecine interne, CHU de Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand cedex 1, France.
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Incidentally detected misty mesentery on CT: risk of malignancy correlates with mesenteric lymph node size. J Comput Assist Tomogr 2012; 36:26-9. [PMID: 22261767 DOI: 10.1097/rct.0b013e3182436c4d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the natural history of incidentally detected misty mesentery on computed tomography (CT) and to correlate the risk of malignancy with size of mesenteric lymph nodes. METHODS A retrospective review of all CT abdomen/pelvic examinations from January 1, 2004 through December 31, 2008 identified cases of misty mesentery. The largest mesenteric lymph node was measured, and additional areas of lymphadenopathy were identified. Follow-up was obtained by reviewing all subsequent CT examinations, clinical notes, and pathologic specimens. Patients were excluded if they had a known malignancy at the time of initial CT, CT or clinical history revealing a cause for the misty mesentery, or CT follow-up of less than 2 years. RESULTS Thirty-seven patients with misty mesentery were included. The mean time from the original CT to the latest follow-up was 3.8 years. The largest lymph node measured less than 10 mm in 30 (81%) of 37 patients. All 30 patients demonstrated stable lymph node size, had no other regions with lymphadenopathy, and none developed malignancy. The largest lymph node was 10 mm or greater in 7 (19%) of 31 patients. Three of these patients developed non-Hodgkin lymphoma, 2 of which had other areas of lymphadenopathy. No cases of nonlymphomatous malignancy were identified. CONCLUSIONS The development of malignancy in patients with incidentally detected misty mesentery correlates with mesenteric lymph node size. Patients with misty mesentery and largest mesenteric lymph node less than 10 mm without additional areas of lymphadenopathy demonstrate a benign course, and no further follow-up may be necessary.
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Multidetector-row computed tomography findings of sclerosing mesenteritis with associated diseases and its prevalence. Jpn J Radiol 2011; 29:495-502. [PMID: 21882092 DOI: 10.1007/s11604-011-0587-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 03/09/2011] [Indexed: 12/15/2022]
Abstract
PURPOSE Our aim was to report the multidetector-row computed tomography (MDCT) findings of sclerosing mesenteritis, which is a rare disease characterized by chronic nonspecific inflammation of mesenteric adipose tissue. It has associated diseases, and we explored its prevalence. MATERIALS AND METHODS A total of 2100 patients were evaluated retrospectively for sclerosing mesenteritis between December 2007 and May 2009. Signs and symptoms, associated diseases, laboratory data, surgical histories, and related findings of a misty mesentery, which corresponds to sclerosing mesenteritis on MDCT, were recorded. RESULTS Misty mesentery findings were seen in 51 (2.43%; 35 men) patients. Their ages ranged between 33 and 78 years (mean 56.2 years). The most frequent complaint of patients was abdominal pain (n = 19; 37.2%). The most prominent possible causative and/or associated factors in our study were malignancy (n = 9; 17.6%), previous surgery (n = 17; 33.3%), smoking (n = 20; 39.2%), coronary artery disease (n = 9; 17.6%), urolithiasis (n = 10; 19.6%), hypertension (n = 18; 35.2%), hyperlipidemia (n = 13; 25.5%), and diabetes mellitus (n = 11; 21.5%). On MDCT, density values in mesenteric fat (-62.8 ± 18.6 HU) were significantly higher than the values for subcutaneous (-103.9 ± 5.8 HU) and retroperitoneal (-105 ± 6 HU) fatty tissues (both P < 0.0001). A partially hyperdense stripe (n = 37; 72.6%), well-defined soft tissue nodules (100%), hypodense fatty halo enclosing vessels (n = 1; 1.9%), and nodules (n = 12; 23.5%) were demonstrated in most of the patients. CONCLUSION The diagnosis of sclerosing mesenteritis has increased with the more frequent use of MDCT and the popularization of the DICOM viewer. Defined hallmarks on MDCT can be helpful for differentiating sclerosing mesenteritis from other pathologies.
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Filippone A, Cianci R, Di Fabio F, Storto ML. Misty mesentery: a pictorial review of multidetector-row CT findings. Radiol Med 2010; 116:351-65. [DOI: 10.1007/s11547-010-0610-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/22/2010] [Indexed: 12/13/2022]
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Benign mesenteric lipodystrophy presenting as low abdominal pain: a case report. J Med Case Rep 2010; 4:119. [PMID: 20423496 PMCID: PMC2871269 DOI: 10.1186/1752-1947-4-119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/27/2010] [Indexed: 01/22/2023] Open
Abstract
Introduction Benign mesenteric lipodystrophy is rare and often presents in a non-specific fashion. Imaging findings may mimic a range of malignant conditions, particularly malignant ovarian disease in women. Case presentation We present the case of a 61-year-old Caucasian woman who was referred to the gynaecology service at our institution and was thought to have ovarian malignancy, and required a laparotomy. However, histopathological analysis unexpectedly revealed benign mesenteric lipodystrophy. Conclusion Benign mesenteric lipodystrophy may mimic a range of conditions, particularly malignancy.
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Epiploic appendagitis: an entity frequently unknown to clinicians--diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol 2009; 193:1243-51. [PMID: 19843737 DOI: 10.2214/ajr.08.2071] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or spontaneous thrombosis of the epiploic appendage central draining vein. When it occurs on the right side of the abdomen, it can mimic appendicitis and right-sided diverticulitis; whereas when it occurs on the left side of the abdomen, it is often mistaken for sigmoid diverticulitis. The purpose of this article is to review the diagnostic imaging of this entity. CONCLUSION Epiploic appendagitis is self-limited and spontaneously resolves without surgery within 5-7 days. Therefore, it is imperative for radiologists to be familiar with this entity.
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Marin D, Catalano C, Baski M, Di Martino M, Geiger D, Di Giorgio A, Sibio S, Passariello R. 64-Section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings. ACTA ACUST UNITED AC 2009; 35:694-700. [DOI: 10.1007/s00261-008-9464-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 08/10/2008] [Accepted: 09/08/2008] [Indexed: 11/30/2022]
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Ba-Ssalamah A, Uffmann M, Bastati N, Schima W. [Diseases of the peritoneum and mesenterium]. Radiologe 2009; 49:637-51; quiz 652-4. [PMID: 19224192 DOI: 10.1007/s00117-008-1766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peritoneal diseases can be seen in the different imaging modalities either as fluid collections or solid tumors along the ligaments, mesenteries, and spaces of the peritoneal cavity. The broad spectrum of different abnormalities includes inflammatory, infectious, traumatic, and neoplastic diseases. In this article, a large variety of peritoneal abnormalities such as ascites, peritonitis, intraperitoneal hemorrhage, and both primary and secondary peritoneal tumors are discussed. The different imaging modalities, characteristic radiological features, and typical pathways of anatomic spread are explained.
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Affiliation(s)
- A Ba-Ssalamah
- Universitätsklinik für Radiodiagnostik, Medizinische Universität, A-1090 Wien, Osterreich.
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Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID. ACTA ACUST UNITED AC 2008; 34:737-42. [DOI: 10.1007/s00261-008-9472-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
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Vettoretto N, Diana DR, Poiatti R, Matteucci A, Chioda C, Giovanetti M. Occasional finding of mesenteric lipodystrophy during laparoscopy: A difficult diagnosis. World J Gastroenterol 2007; 13:5394-6. [PMID: 17879414 PMCID: PMC4171334 DOI: 10.3748/wjg.v13.i40.5394] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mesenteric lipodystrophy is a rare pathological condition affecting the mesentery. Its initial presentation is typically asymptomatic. Pathological characteristics are unspecific, and generally attributed to inflammation, unless the diagnosis is suspected. Laparoscopy done for other reasons has been, as in this case, unsuccessful in providing evidence for the correct diagnosis, thus requiring laparotomy due to lack of diagnostic tissue. After 6 mo no further medical therapy is required, as the patient remains asymptomatic. Discussion of this case and a brief review of the literature are presented in the following paragraphs.
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Affiliation(s)
- Nereo Vettoretto
- General and Vascular Surgery, Az. Osp. M. Mellini, V.le Mazzini 4, Chiari (BS) 25032, Italy.
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Affiliation(s)
- Panuch Yenarkarn
- Department of Radiology, University of California San Francisco Medical School, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628, USA
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Béchade D, Durand X, Desramé J, Rambelo A, Corberand D, Baranger B, Farge D, Algayres JP. [Etiologic spectrum of mesenteric panniculitis: report of 7 cases]. Rev Med Interne 2007; 28:289-95. [PMID: 17316921 DOI: 10.1016/j.revmed.2006.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 12/30/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Mesenteric panniculitis is a rare disorder characterized by nonspecific inflammation and/or necrosis and/or fibrosis in the adipose tissue of the bowel mesentery. Its signification, primary or associated with other diseases, is a subject of controversy. METHODS A descriptive and retrospective study of patients with an abdominal CT examination showing features of mesenteric panniculitis and for whom biopsy with immunohistochemical examination was obtained in all cases. RESULTS Seven patients were enrolled (4 men and 3 women) with a median age of 62,1 years. None of the patients without an identified etiology had a history of abdominal surgery. An associated disease was identified in 4 cases: breast cancer (1), non-Hodgkin's lymphoma based on peripheric lymph nodes biopsy (2) and cryoglobulinemic vascularitis based on renal biopsy (1). In the 3 remaining cases, isolated mesenteric panniculitis was the only abnormality despite thorough imaging and pathologic investigations. CONCLUSION Except an obvious malignancy context or a history of abdominal surgery, a pathologic examination of the mesenteric panniculitis lesions is necessary, especially to eliminate another mesenteric disorder. Mesenteric panniculitis is often associated with lymphoma.
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Affiliation(s)
- D Béchade
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Wat SYJ, Harish S, Winterbottom A, Choudhary AK, Freeman AH. The CT appearances of sclerosing mesenteritis and associated diseases. Clin Radiol 2006; 61:652-8. [PMID: 16843748 DOI: 10.1016/j.crad.2006.02.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 02/03/2006] [Accepted: 02/06/2006] [Indexed: 12/13/2022]
Abstract
Sclerosing mesenteritis is characterized by non-specific inflammation of the mesenteric fat associated with variable amount of fibrosis. The aetiology is unclear; the pathogenesis is obscure, and even its nomenclature remains variable. It is a rare condition with imaging features that can be mistaken either for a mesenteric neoplasm or for a wide variety of non-neoplastic inflammatory conditions. Knowledge of the imaging features of this condition may prevent unwarranted aggressive therapy. This review discusses the pathogenesis, clinical manifestations of this condition, as well as illustrating the characteristic computed tomography (CT) features of sclerosing mesenteritis. A rational approach to the differential diagnosis is discussed.
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Affiliation(s)
- S Y J Wat
- Department of Radiology, Cambridge University Hospitals Foundation NHS Trust, Cambridge, UK.
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McMenamin DS, Bhuta SS. Mesenteric panniculitis versus pancreatitis: a computed tomography diagnostic dilemma. ACTA ACUST UNITED AC 2005; 49:84-7. [PMID: 15727618 DOI: 10.1111/j.1440-1673.2005.01406.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A case of mesenteric panniculitis is described in a patient with CT features mimicking pancreatitis. Emphasis is on the important CT features for accurate diagnosis.
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Affiliation(s)
- D S McMenamin
- Department of Medical Imaging, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, Queensland 4814, Australia.
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Abstract
OBJECTIVE Unsuspected mesenteric lymph nodes are frequently found on abdominal CT scans in everyday clinical practice. What to do with these findings has not been well established. The purpose of this study is to document the incidence of mesenteric lymph nodes in a previously healthy population and to provide guidelines for further management. MATERIALS AND METHODS We examined the CT scans of 132 consecutive patients (84 men and 36 women; age range, 12-90 years; mean age, 43 years) who presented to the emergency department after experiencing blunt abdominal trauma. Twelve patients were excluded because they had disease processes known to be associated with lymphadenopathy. All imaging was performed using 3.2-mm collimation on MDCT scanners with IV contrast material. Two radiologists evaluated the images by consensus and recorded the presence of mesenteric lymph nodes greater than 3 mm in the short axis. Lymph node size, number, and location (central, peripheral, or right lower quadrant) were documented. All studies were reviewed on a PACS workstation. RESULTS Of the 120 patients with otherwise normal CT scans, 47 had mesenteric lymph nodes greater than 3 mm. Of these 47 patients, 22 (47%) had five or more lymph nodes detected. Twenty-five (53%) of the 47 patients had four or fewer nodes. The mean size of the largest nodes was 4.8 mm (range, 3-9 mm), and the mean size of the nodes found per patient was 3.6 mm (range, 3-6 mm). These nodes were identified only at the mesenteric root in 32 patients (68%), only in the mesenteric periphery in eight patients (17%), and only in the right lower quadrant in five patients (11%). Nodes were identified in more than one location in two patients (4%). CONCLUSION Incidental finding of mesenteric lymph nodes is common, reflecting more widespread use of thin-collimation MDCT and PACS workstations. In general, these nodes are small, measuring less than 5 mm. Such nodes when found in an otherwise healthy population are clinically insignificant and require no further imaging.
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Affiliation(s)
- Brian C Lucey
- Department of Radiology, Division of Body Imaging, Boston Medical Center, 88 E Newton St., Atrium 2, Boston, MA 02118, USA
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Suzuki S, Furui S, Kohtake H, Sakamoto T, Yamasaki M, Furukawa A, Murata K, Takei R. Isolated dissection of the superior mesenteric artery: CT findings in six cases. ACTA ACUST UNITED AC 2004; 29:153-7. [PMID: 15290937 DOI: 10.1007/s00261-003-0110-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Dissection of the superior mesenteric artery (SMA) not associated with aortic dissection is rare. The purpose of this study is to describe the computed tomographic (CT) findings of this condition. We studied the CT findings of six patients with isolated dissection of the SMA. CT demonstrated thrombosis of the false lumen or intramural hematoma (n = 4) and/or intimal flap (n = 4) in all six patients. Other CT findings were enlarged diameter of the SMA (n = 5), increased attenuation of the fat around the SMA (n = 5), and hematoma in the mesentery with hemorrhagic ascites (n = 1). CT is useful for the diagnosis of isolated dissection of the SMA, and increased attenuation of the fat around the artery is considered the key to the diagnosis when no definite findings are evident.
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Affiliation(s)
- S Suzuki
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
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van Breda Vriesman AC, Schuttevaer HM, Coerkamp EG, Puylaert JBCM. Mesenteric panniculitis: US and CT features. Eur Radiol 2004; 14:2242-8. [PMID: 15300397 DOI: 10.1007/s00330-004-2429-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Revised: 05/27/2004] [Accepted: 06/14/2004] [Indexed: 12/25/2022]
Abstract
Mesenteric panniculitis is an aseptic inflammation of mesenteric fat. Before the age of ultrasonography (US) and computed tomography (CT), mesenteric panniculitis was rarely diagnosed, but today the disorder is more commonly encountered, often as an incidental imaging finding. Its exact cause remains unknown. This review illustrates the characteristic US and CT features of mesenteric panniculitis and discusses its differential diagnosis.
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Affiliation(s)
- A C van Breda Vriesman
- Department of Radiology, Rijnland Hospital, Simon Smitweg 1, Leiderdorp, The Netherlands
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Horton KM, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 2004; 23:1561-7. [PMID: 14615565 DOI: 10.1148/rg.1103035010] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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.
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Affiliation(s)
- Karen M Horton
- Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Rm 3251, Baltimore, MD 21287, USA
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