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Ausín-García C, Cervilla-Muñoz E, Demelo-Rodríguez P, Villalba-García MV, Alvarez-Sala Walther LA. Visceral extra-abdominal panniculitis after COVID19. Int J Rheum Dis 2022; 26:793-796. [PMID: 36565466 DOI: 10.1111/1756-185x.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022]
Abstract
"Retractile mesenteritis" was the first name given to a rare, benign, inflammatory disease that affects the adipose tissue of the intestinal mesentery and less frequently other locations. Now labeled as mesenteric panniculitis, the pathogenic mechanism remains unclear. Several stimuli could be involved, and it is sometimes associated with other conditions such as malignancy or autoimmune diseases. We present a case of mesenteric panniculitis with extensive abdominal and extra-abdominal involvement that developed a few months after SARS-COV2 infection, raising the hypothesis of this virus as a potential trigger for autoinflammatory and autoimmune diseases.
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Affiliation(s)
- Cristina Ausín-García
- Internal Medicine Service, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Eva Cervilla-Muñoz
- Internal Medicine Service, General University Hospital Gregorio Marañón, Madrid, Spain
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CT features associated with underlying malignancy in patients with diagnosed mesenteric panniculitis: Mesenteric panniculitis: CT features associated with underlying malignancy. Diagn Interv Imaging 2022; 103:394-400. [PMID: 35843840 DOI: 10.1016/j.diii.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to identify abdominal computed tomography (CT) features associated with underlying malignancy in patients with mesenteric panniculitis (MP). MATERIALS AND METHODS This single-institution retrospective longitudinal cohort study included patients with MP and a minimum 1-year abdominopelvic CT follow-up or 2-year clinical follow-up after initial abdominopelvic CT examination. Two radiologists, blinded to patients' medical records, conjointly reviewed CT-based features of MP. Electronic medical records were reviewed for newly diagnosed malignancies with the following specific details: type (lymphoproliferative disease or solid malignancy), location (possible mesenteric drainage or distant), stage, time to diagnosis. An expert panel of three radiologists and one hemato-oncologist, who were blinded to the initial CT-based MP features, assessed the probability of association between MP and malignancy based on the malignancy characteristics. RESULTS From 2006 to 2016, 444 patients with MP were included. There were 272 men and 172 women, with a median age of 64 years (age range: 25-89); the median overall follow-up was 36 months (IQR: 22, 60; range: 12-170). A total of 34 (8%) patients had a diagnosis of a new malignancy; 5 (1%) were considered possibly related to the MP, all being low-grade B-cell non-Hodgkin lymphomas. CT features associated with the presence of an underlying malignancy were the presence of an MP soft-tissue nodule with a short axis >10 mm (P < 0.0001) or lymphadenopathy in another abdominopelvic region (P < 0.0001). Associating these two features resulted in high diagnostic performance (sensitivity 100%; [95% CI: 57-100]; specificity 99% [95% CI: 98-100]). All related malignancies were identified. CONCLUSION Further workup to rule out an underlying malignancy is only necessary in the presence of an MP soft-tissue nodule >10 mm or associated abdominopelvic lymphadenopathy.
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Wagner C, Dachman A, Ehrenpreis ED. Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition. Clin Colon Rectal Surg 2022; 35:342-348. [PMID: 35966977 PMCID: PMC9365492 DOI: 10.1055/s-0042-1743588] [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
Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis. There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions. While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.
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Affiliation(s)
- Christopher Wagner
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Abraham Dachman
- Department of Radiology, University of Chicago Hospital, Chicago, Illinois
| | - Eli D. Ehrenpreis
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
- Department of Medicine, Rosalind Franklin University Medical School, North Chicago, Illinois
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Hussain I, Ishrat S, Aravamudan VM, Khan SR, Mohan BP, Lohan R, Abid MB, Ang TL. Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29143. [PMID: 35512070 PMCID: PMC9276205 DOI: 10.1097/md.0000000000029143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP. METHODS MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated. RESULTS Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group. CONCLUSION This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.
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Affiliation(s)
- Ikram Hussain
- Division of Gastroenterology, Department of Medicine, Woodlands Health Campus, Singapore
| | | | | | - Shahab R. Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Babu P. Mohan
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, UT
| | - Rahul Lohan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Muhammad Bilal Abid
- Divisions of Infectious Diseases & Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
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Tee LY, Sim L, Tan LF, Lum J, Seetharaman SK. GIST of the stomach masquerading as recurrent falls in an older adult: a case report and review. BMC Gastroenterol 2021; 21:381. [PMID: 34663231 PMCID: PMC8522095 DOI: 10.1186/s12876-021-01964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gastric tumors become increasingly prevalent with advanced age but can be challenging to diagnose in older adults who may present with non-specific symptoms. Here, we report a rare case of an occult gastric tumor associated with mesenteric panniculitis that presented with recurrent falls precipitated by vertigo. CASE PRESENTATION We describe a diagnostically challenging case of cryptogenic gastric tumor associated with mesenteric panniculitis in a 74-year-old female who presented with abdominal bloating and recurrent falls precipitated by vertigo, dehydration, acute kidney injury and electrolyte deficiencies, but had no alarm symptoms. Her symptoms resolved after laparoscopic wedge resection of the gastric tumor. CONCLUSIONS Our case highlights that while alarm symptoms such as dysphagia, weight loss, gastrointestinal bleeding and vomiting are considered indications for endoscopy, clinicians should also maintain a high index of suspicion for gastric tumors in older patients who may present with atypical symptoms.
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Affiliation(s)
- Louis Y Tee
- Division of Healthy Ageing, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore.
| | - Lynette Sim
- Division of Healthy Ageing, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore
| | - Li Feng Tan
- Division of Healthy Ageing, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore
| | - Jeffrey Lum
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Santhosh Kumar Seetharaman
- Division of Healthy Ageing, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore
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Sá J, Evangelista C, Jorge CF, Silva J. Bilateral pleural effusions as the first sign of mesenteric panniculitis. BMJ Case Rep 2020; 13:13/7/e233423. [PMID: 32675113 DOI: 10.1136/bcr-2019-233423] [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: 11/04/2022] Open
Abstract
A 38-year-old woman presented to the emergency department with a history of thoracic pain and anorexia for 1 week. Thoracic CT scan showed bilateral pleural effusion, a thoracentesis was performed revealing a transudate liquid with polymorphonuclears and predominance of eosinophils. After admission, the patient developed abdominal pain and the abdominal CT scan showed densification of the mesenteric fat characteristic of mesenteric panniculitis (MP). The patient went through investigation for secondary causes of panniculitis including infection, neoplasia and autoimmune diseases, and no abnormalities were found. The patient was treated with corticosteroids over a period of 3 months with complete resolution and without any signs of remission or secondary cause of MP. Moreover, the patient remained asymptomatic for 2 years after being discharged, which strengthens the diagnosis of MP that presented with eosinophilic pleural effusion.
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Affiliation(s)
- Juliana Sá
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal .,University of Beira Interior, Covilhã, Portugal
| | - Céu Evangelista
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - Clara F Jorge
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - João Silva
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
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Bansal P, Gilbert EL, Pereira ROL, Virata AR. Mesenteric panniculitis in a patient with new onset dermatomyositis. BMJ Case Rep 2020; 13:13/1/e232183. [PMID: 32014990 DOI: 10.1136/bcr-2019-232183] [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: 11/04/2022] Open
Abstract
Mesenteric panniculitis (MP), part of the spectrum of sclerosing mesenteritis, is an often asymptomatic disorder that is characterised by chronic inflammation of abdominal mesentery. We present a case of an 83-year-old woman who presented with proximal muscle weakness and erythematous, photosensitive rash of the face and upper torso and was subsequently diagnosed with dermatomyositis based on skin biopsy, electromyography and muscle biopsy. She had radiographic evidence of panniculitis on CT scan of the abdomen and pelvis for malignancy surveillance, which improved on serial CT scan 3 months after beginning treatment for her underlying dermatomyositis with prednisone and mycophenolate mofetil. Our case highlights that MP can be associated with underlying autoimmune disease. Connective tissue disease could be considered in the differential of MP when other etiologies such as surgery, trauma and malignancy are ruled out.
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Affiliation(s)
- Pankaj Bansal
- Rheumatology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Emily L Gilbert
- Internal Medicine, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | | | - Andrew R Virata
- Pathology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
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A diagnostic dilemma: Pedunculated mesenteric lipodystrophy mimicking Meckel’s diverticulum. A case report and literature review. Int J Surg Case Rep 2020; 72:183-187. [PMID: 32544826 PMCID: PMC7298552 DOI: 10.1016/j.ijscr.2020.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
Mesenteric lipodystrophy is a rare fibroinflammatory disease of unknown origin. The detection of mesenteric lipodystrophy is challenging and requires early clinical suspicion. Clinical and imaging findings can mimick other pathological conditions affecting the mesenteric fat tissue. Contrast enhanced CT is the most accurate imaging technique for diagnosing mesenteric lipodystrophy.
Introduction Mesenteric lipodystrophy is a rare fibroinflammatory disease of unknown origin with clinical and radiological non specific findings. Presentation of the case The case of a 42-years-old man affected by a pedunculated mesenteric lipodystrophy mimicking Meckel’s diverticulum is reported. Clinical, imaging and histological findings are discussed. Discussion Mesenteric lipodystrophy affects the mesenteric fat of the abdomen with a typical diffuse thickening of the mesentery, nodular thickening of the mesenteric root and presence of mass-like lesions. Ultrasound (US) and Multiphasic Computed Tomography (CT) represent the main imaging tools used for diagnosis. Clinical and imaging findings can mimick other pathological conditions affecting the mesenteric fat tissue. Contrast enhanced CT is the most accurate imaging technique for diagnosing mesenteric lipodystrophy due to the high panoramicity and accuracy with multiplanar imaging. Multiphasic technique helps to characterize the lesion and to recognize vascular anatomy. Oral administration of iodinated contrast medium may help to assess the relationship with bowel loops. All these diagnostic elements are crucial for the surgical timing and approach. Conclusions Due to the heterogeneous mesenteric involvement, the nonspecific CT findings and the high number of diseases for differential diagnosis, the detection of mesenteric lipodystrophy is challenging and requires early clinical suspicion. An histological examination is always necessary.
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Dahiya DS, Kichloo A, Singh J, Albosta MS, Wani F, Aljadah M, Haq KF. Acute Recurrent Exacerbations of Mesenteric Panniculitis With Immunosuppressive Therapy: A Case Report and a Brief Review. J Investig Med High Impact Case Rep 2020; 8:2324709620969581. [PMID: 33138661 PMCID: PMC7649945 DOI: 10.1177/2324709620969581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mesenteric panniculitis (MP) is a rare, benign, and idiopathic disorder characterized by chronic inflammation of the mesenteric adipose tissue of the small intestine. The exact etiology of MP is unknown and its associations with underlying malignancies continues to be poorly understood. In this case report, we describe a rare case of acute exacerbations of MP in a middle-age female with a known past medical history of non-Hodgkin’s lymphoma in remission and small bowel resection for a localized carcinoid tumor. The patient was diagnosed with MP 4 years ago and started on tamoxifen therapy with adequate control of her symptoms. Last year, she reported to the emergency department with multiple episodes of sudden-onset, severe, and localized right upper quadrant abdominal pain and nausea without vomiting. She was diagnosed with an acute exacerbation of MP and a decision was made to add 60 mg prednisone daily in addition to her tamoxifen regimen. She remained symptomatically stable for the next 6 months after the start of dual therapy with tamoxifen and prednisone. However, for the past 6 months, the patient reported to the emergency department on an average of 2 times/month with the same recurrent symptoms despite high compliance with tamoxifen and prednisone therapy. She was admitted for her pain management and her dose of prednisone was increased and she was subsequently discharged home with improvement of her symptoms. Her tamoxifen was switched to mycophenolate on her follow-up visit with gastrointestinal clinic, and her disease has remained stable for the past 2 months. Our case report discusses in-depth the literature on MP and its management. We also detail the steps in management of a rare case of recurrent acute exacerbations of MP despite the patient being on immunosuppressive therapy.
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Affiliation(s)
| | | | | | | | - Farah Wani
- Central Michigan University, Saginaw, MI, USA
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10
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Buragina G, Magenta Biasina A, Carrafiello G. Clinical and radiological features of mesenteric panniculitis: a critical overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:411-422. [PMID: 31910164 PMCID: PMC7233778 DOI: 10.23750/abm.v90i4.7696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
The mesenteric panniculitis is a rare form of inflammation that mainly involves the mesenteric adipose tissue. The etiology remains unknown and the disease has been associated with various conditions such as cancer, abdominal trauma, previous surgery, autoimmune diseases and obesity. Mesenteric panniculitis can be divided into two main groups: the mesenteric panniculitis with only the inflammation and degeneration of the mesenteric fat, and the retractile panniculitis, mainly fibrotic, with retraction of the surrounding structures. From a radiological point of view, there are two main signs: the fat ring sign, which is the presence of normal fat around vessels and lymph nodes, and the pseudocapsula around the lesion. In this paper, we present the imaging and clinical features of mesenteric panniculits with particular reference to the differential diagnosis and the possible etiological associations. (www.actabiomedica.it)
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Meyyur Aravamudan V, Khan SR, Natarajan SK, Hussain I. The Complex Relationship between Mesenteric Panniculitis and Malignancy - A Holistic Approach is Still Needed to Understand the Diagnostic Uncertainties. Cureus 2019; 11:e5569. [PMID: 31695988 PMCID: PMC6820662 DOI: 10.7759/cureus.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Mesenteric panniculitis is an idiopathic, localized inflammation involving the adipose tissue of the small bowel mesentery. The association of mesenteric panniculitis with malignancy, predominantly lymphomas, has been widely reported in the medical literature. In this review article, we will discuss the clinical guidelines in the diagnosis and management of mesenteric panniculitis and the clinical association between mesenteric panniculitis and malignancies.
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Affiliation(s)
| | - Shahab R Khan
- Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, USA
| | | | - Ikram Hussain
- Internal Medicine: Gastroenterology, Woodlands Health Campus, Singapore, SGP
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Abstract
BACKGROUND Sclerosing mesenteritis (SM) and mesenteric panniculitis are rare processes of the mesentery which pose a major clinical and imaging challenge. This review article attempts to introduce a systematic nomenclature to address typical symptoms, imaging and major differential diagnoses. RESULTS SM with its subtypes-mesenteric lipodystrophy, panniculitis and retractile mesenteritis-is a chronic process with a very diverse and heterogeneous clinical appearance. The typical radiological characteristics ("misty mesentery", increased lymph nodes, pseudocapsule and "fat halo") are also not very specific. A link between SM and malignant diseases is not proven, but there is controversial discussion. Therefore, if there are doubts about the diagnosis, further examinations and a biopsy are desired. CONCLUSION When diagnosing SM, "red flags", i. e. characteristics that are atypical for SM in imaging, should be considered. In case of ambiguous imaging, differential diagnostics should also consider malignant diseases and exclude them.
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Abstract
Sclerosing mesenteritis is a rare non-neoplastic disorder characterized by fat necrosis, chronic inflammation, and fibrosis typically of the small bowel mesentery. Our understanding of this disorder is limited by its rarity as well as inconsistent terminology used across the literature. While prior abdominal surgery or trauma, autoimmunity, infection, ischemia, and malignancy have been suggested to be involved in the pathogenesis of the disorder, it remains poorly understood. The clinical course of sclerosing mesenteritis is generally benign with a large proportion of patients diagnosed incidentally on imaging obtained for other indications. In a subset of patients, symptoms may arise from a mass effect on the bowel, lymphatics, or vasculature resulting in bowel obstruction, chylous ascites, or mesenteric ischemia. Symptomatic patients should be treated with a combination of corticosteroid and tamoxifen as first-line therapy based on retrospective case series and experience in other fibrosing disorders. Surgical intervention may be required in those with persistent obstruction despite conservative treatment, though complete resection of the mass is often not feasible given intimate involvement with the mesenteric vasculature. A careful use of terminology and communication between the radiologist, pathologist, and clinicians in the care of these patients will be essential to future efforts at understanding this disease.
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Zhao ME, Zhang LQ, Ren L, Li ZW, Xu XL, Wang HJ, Wang ZX, Li HL, Bao YY, Fan HN, Yangdan CR. A case report of mesenteric panniculitis. J Int Med Res 2019; 47:3354-3359. [PMID: 31122101 PMCID: PMC6683908 DOI: 10.1177/0300060519845785] [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] [Indexed: 12/30/2022] Open
Abstract
A 65-year-old man had intermittent abdominal pain for the previous 2 years. This pain suddenly became worse with a fever and elevated inflammatory markers. We took a while to diagnose the patient with mesenteric panniculitis (MP). Although imaging findings suggested MP, we needed to rule out other diseases. Choosing a treatment for the patient also took some time and we finally used glucocorticoid to cure the patient.
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Affiliation(s)
- Ming-En Zhao
- 1 Medical College of Qinghai University, Xining, China.,2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Ling-Qiang Zhang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Li Ren
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Zhen-Wei Li
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Xiao-Lei Xu
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Jiu Wang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Zhi-Xin Wang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Long Li
- 4 Department of Medical Central Imaging, The Affiliated Hospital of Qinghai University, Xining, China
| | - Yuan-Yuan Bao
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,4 Department of Medical Central Imaging, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Ning Fan
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,3 Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
| | - Cai-Rang Yangdan
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
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Er C, Tey VHT, Kuthiah N, Aravamudan VM. A case of mesenteric panniculitis associated with metastatic poorly differentiated cancer of unknown primary site. Oxf Med Case Reports 2019; 2019:omz023. [PMID: 31001427 PMCID: PMC6463832 DOI: 10.1093/omcr/omz023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/22/2019] [Accepted: 03/02/2019] [Indexed: 11/15/2022] Open
Abstract
Mesenteric panniculitis is the inflammation of intestinal mesentery. It may be associated with malignancy. We present a case of mesenteric panniculitis that manifested as unresolved fever which subsequently was found to be due to poorly differentiated metastatic carcinoma.
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Affiliation(s)
- Chaozer Er
- Department of General Medicine, Woodlands Health Campus, 2 Yishun Central 2, Singapore
| | | | - Navin Kuthiah
- Department of General Medicine, Woodlands Health Campus, 2 Yishun Central 2, Singapore
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Al-Omari MH, Qararha K, Garaleh M, Smadi MM, Hani MB, Elheis M. Mesenteric panniculitis: comparison of computed tomography findings in patients with and without malignancy. Clin Exp Gastroenterol 2018; 12:1-8. [PMID: 30643446 PMCID: PMC6311320 DOI: 10.2147/ceg.s182513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose The aim was to compare computed tomography (CT) findings between patients with mesenteric panniculitis (MP) with and without known malignancy. Patients and methods We retrospectively analyzed 116 consecutive patients who were diagnosed with MP on the basis of CT findings and categorized them according to the absence (Group 1: 73 patients) or presence (Group 2: 43 patients) of malignancy. Patient age and sex, diameter, size, mass effect, location, and fat density of the MP mass, presence of a pseudocapsule and/or halo sign, and lymph node status were compared between the two groups. Results MP tends to be more common in males, and this trend shows statistical significance when combining the findings for both groups (P=0.041). Patients in Group 1 were significantly younger than those in Group 2 (54.29 vs 64.77 years, P=0.001). A well-defined fatty mass at the small bowel root was observed in all patients. The halo sign was present in most cases in both groups. A pseudocapsule was observed in 36 patients (49%) in Group 1 and 29 (67%) in Group 2 (P=0.045). The average craniocaudal diameter of the MP masses on the sagittal view was 11.14 and 12.5 cm in Groups 1 and 2, respectively (P=0.005). The MP fat density was less negative in patients with malignancy (–66 vs –76 HU, P=0.001). Lymph node status was similar in both groups. Conclusion Detailed CT features should be evaluated in patients with MP, as some of these features may indicate an associated malignancy, necessitating further investigation and close follow-up.
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Affiliation(s)
- Mamoon H Al-Omari
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Khaleel Qararha
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Mohammed Garaleh
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Mahmoud M Smadi
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Bani Hani
- Department of Surgery, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Mwaffaq Elheis
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
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17
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Sousa D, Varela AV, Coelho MV, Jorge C. Mesenteric panniculitis: diagnostic precision. BMJ Case Rep 2018; 2018:bcr-2017-223977. [PMID: 30317189 DOI: 10.1136/bcr-2017-223977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an elevated C reactive protein serum level. Serologies for infection were negative. Blood cultures grew no organisms. Colonoscopy revealed normal findings. CT showed typical findings of mesenteric panniculitis with infiltration of mesenteric fat that was circumscribed by hyperattenuating capsule and contained enlarged homogenous lymph nodes. The histopathological analysis from mesenterium revealed non-specific signs of chronic inflammation. On institution of prednisolone, the clinical symptoms subsided, and we replaced it with azathioprine after 1 month. After 12 months of therapy, the patient remained asymptomatic, normalised the serological inflammatory markers and repeat CT revealed normal mesenteric fat.
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Affiliation(s)
- Domingos Sousa
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana Verónica Varela
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Catarina Jorge
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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18
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Mahafza WS, Manzalawi KA, Gharaibeh AA, Khayat OW, Shahait A, Juweid ME. Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history. Saudi Med J 2018; 38:1013-1018. [PMID: 28917065 PMCID: PMC5694634 DOI: 10.15537/smj.2017.10.20163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To assess the prevalence and associations of mesenteric panniculitis (MP) using multi-detector CT (MDCT). METHODS This retrospective study included 4758 consecutive patients who underwent abdomino-pelvic MDCT between January 2012 and December 2014 at Jordan University Hospital, Amman, Jordan. Radiological database was searched for MP diagnosis and patients with suspected MP were re-evaluated by an experienced radiologist to confirm the diagnosis. Data on all patients with confirmed MP diagnosis were subsequently collected and analyzed. RESULTS Computed tomography features of MP were identified in 90 patients (41 males, 49 females), a prevalence of 1.9%. Mesenteric panniculitis was identified in both asymptomatic and symptomatic patients. Malignancy was found in 28 MP patients (31%) and 44 of the MP patients (49%) had prior history of abdomino-pelvic surgery. Mesenteric panniculitis was significantly more frequently associated with prior abdomino-pelvic surgery (p=0.0001) and the likelihood of associated malignancy in patients with MP was 2.1-fold higher than in patients without MP (p=0.0013). Conclusion: Mesenteric panniculitis can be reliably diagnosed by MDCT due to its typical CT appearance. Its identification is important because of its significant association with malignancy and because it represents one of the differential diagnoses in patients with nonspecific symptoms referred for abdomino-pelvic CT.
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Affiliation(s)
- Waleed S Mahafza
- Diagnostic Radiology Department, The Jordan University Hospital, Amman, Jordan. E-mail.
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19
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Scharitzer M, Tamandl D, Ba-Ssalamah A. [Incidental findings of the kidneys, adrenal glands, adnexa uteri, gastrointestinal tract, mesentery and lymph nodes : Assessment and management recommendations]. Radiologe 2018; 57:279-285. [PMID: 28283731 DOI: 10.1007/s00117-017-0236-9] [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: 10/20/2022]
Abstract
CLINICAL ISSUE Besides the upper abdominal parenchymal organs, the increasing application of cross-sectional imaging has also led to a rising number of incidental findings in the kidneys, adrenal glands, adnexa uteri, the gastrointestinal tract, mesentery and abdominal lymph nodes. STANDARD RADIOLOGICAL METHODS Abdominal computed tomography investigations often show unexpected findings without any correlating symptoms. The growing clinical relevance is due to the large number of incidental findings as well as an increasing awareness of ethical and socioeconomic factors. ACHIEVEMENTS When interpreting radiological findings not only morphological criteria but also individual risk factors of the patient and the clinical context are of great importance. PRACTICAL RECOMMENDATIONS The aims of this article are the description and evaluation of frequent incidental findings detected by computed tomography and to provide information about management recommendations.
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Affiliation(s)
- M Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - D Tamandl
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - A Ba-Ssalamah
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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20
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Khasminsky V, Ram E, Atar E, Steinminz A, Issa N, Bachar GN. Is there an association between mesenteric panniculitis and lymphoma? A case control analysis. Clin Radiol 2017; 72:844-849. [PMID: 28712750 DOI: 10.1016/j.crad.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/27/2017] [Accepted: 05/09/2017] [Indexed: 12/18/2022]
Abstract
AIM To determine the prevalence and association of mesenteric panniculitis (MP) in a group of patients with non-Hodgkin's lymphoma (NHL) compared to control group. MATERIALS AND METHODS We retrospectively evaluated computed tomography (CT) and combined positron-emission tomography (PET) with CT examinations of a total of 166 patients who were diagnosed with NHL over a period of 5 years (2008-2013). The control group consisted of 332 subjects who were matched for gender and age at the time period the examinations were performed on the study group. A combination of radiological signs and absence of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-uptake was used to establish the diagnosis of MP and distinguish it from the involvement of mesentery by lymphoma. RESULTS MP was identified in three patients (prevalence 1.8%) from the study group as compared to seven subjects out of 332 (2.1%) in the control group (p=0.556). During the course of follow-up no changes in the imaging features of MP were seen in either group. Additionally, 27 (16.2%) patients from the study group were found to have changes in the mesentery, which were attributed to the involvement of the mesentery in the primary disease. CONCLUSION The prevalence of MP among patients with NHL was found to be 1.8%, which corresponds to the range of its prevalence in the general population. This is contrary to the proposition that MP is associated with NHL.
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Affiliation(s)
- V Khasminsky
- Department of Diagnostic Imaging, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - E Atar
- Department of Diagnostic Imaging, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Steinminz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Nuclear Medicine, Rabin Medical Center, Petach Tikva, Israel
| | - N Issa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - G N Bachar
- Department of Diagnostic Imaging, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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