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Bhatia H, Sinha A, Mishra A. Acute Epigastric Pain: Unexpected Urologic Findings on Computed Tomography. Urology 2023; 176:e10-e12. [PMID: 37030578 DOI: 10.1016/j.urology.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Mesenteric panniculitis is a relatively common condition encountered on cross-sectional imaging and is mostly asymptomatic. We present one such case where an underlying malignancy was brought to forefront due to associated mesenteric panniculitis presenting as acute abdomen.
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Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Anand Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Celis Pinto JC, Hernández Peláez L, Mendoza Pacas G, Mayordomo Colunga J, Balbín M, Pitiot A, Torres-Rivas HE, Blanco Lorenzo V. Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report. Autops Case Rep 2023; 13:e2023434. [PMID: 37292389 PMCID: PMC10247287 DOI: 10.4322/acr.2023.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 06/10/2023]
Abstract
Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.
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Affiliation(s)
- Juan Carlos Celis Pinto
- Hospital Universitario Central de Asturias (HUCA), Pathology Department, Oviedo, Asturias, Spain
| | - Lucía Hernández Peláez
- Hospital Universitario Central de Asturias (HUCA), Pediatric Department, Oviedo, Asturias, Spain
| | - Guillermo Mendoza Pacas
- Hospital Universitario Central de Asturias (HUCA), Pathology Department, Oviedo, Asturias, Spain
| | - Juan Mayordomo Colunga
- Hospital Universitario Central de Asturias (HUCA), Pediatric Intesive Care Unit, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Cataluña, Spain
| | - Milagros Balbín
- Hospital Universitario Central de Asturias (HUCA), Medicine Laboratory, Oviedo, Asturias, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Molecular Oncology Laboratory, Oviedo, Asturias, Spain
- Instituto de Investigación Biosanitaria de Asturias, Oviedo, Asturias, Spain
| | - Ana Pitiot
- Hospital Universitario Central de Asturias (HUCA), Medicine Laboratory, Oviedo, Asturias, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Molecular Oncology Laboratory, Oviedo, Asturias, Spain
- Instituto de Investigación Biosanitaria de Asturias, Oviedo, Asturias, Spain
| | | | - Verónica Blanco Lorenzo
- Hospital Universitario Central de Asturias (HUCA), Pathology Department, Oviedo, Asturias, Spain
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Asghar MS, Tauseef A, Naman D, Zafar M, Rasheed U, Khan N, Alvi H, Shaikh N. Mesenteric Panniculitis in a Patient with Homozygous Factor V Leiden Gene Mutation: A Case and Literature to Review. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 30-year-old Asian male with a significant history of deep vein thrombosis and family history positive for pulmonary embolism presented with complaints of fever, nonradiating epigastric pain, and a sense of abdominal fullness. After the initial workup, ultrasonography of the whole abdomen was carried out which showed thrombus formation in the portal vein. A CT scan of the abdomen was performed, which showed findings suggestive of mesenteric panniculitis. Keeping the significant family history and imaging findings in mind, the clotting and thrombin profiles were analysed and came back positive for the factor V Leiden gene (homozygous). A CT angiogram was performed to demonstrate extensive thrombosis throughout the abdominal vasculature with cavernous transformation. It is asserted that the chronic thrombosis on a background of factor V mutation led towards chronic inflammation of the mesentery. To the authors’ knowledge it is the first reported case of mesenteric panniculitis in a patient with factor V homozygous gene mutation.
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Affiliation(s)
| | - Abubakar Tauseef
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Durre Naman
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Maryam Zafar
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Uzma Rasheed
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Narmin Khan
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Haris Alvi
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimra Shaikh
- Liaquat National Hospital and Medical College, Karachi, Pakistan
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Mesenteric panniculitis mimicking early recurrence at end-of-treatment evaluation in malignant lymphoma: Differentiation by active surveillance with F-18 FDG PET/CT imaging. Radiol Case Rep 2020; 15:1006-1010. [PMID: 32426085 PMCID: PMC7226656 DOI: 10.1016/j.radcr.2020.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/23/2022] Open
Abstract
Mesenteric panniculitis is a relatively rare fibro-inflammatory condition of the mesentery. In acute phase, it demonstrates avid uptake on Fluorine-18 FDG PET/CT (PET/CT). Thorough assessment is needed to differentiate from viable or recurrent disease in patients with malignant lymphoma because it mimics active lymphomatous disease on PET/CT. In this article, 3 illustrative cases of malignant lymphoma are presented. PET/CT demonstrated new FDG-avid mesenteric lesions at the end-of-treatment evaluation while the original disease showed significant response. Early recurrence was initially suspected, but together with clinical course and findings, active surveillance was opted. Sequential follow-up PET/CTs showed various patterns of metabolic activity over time; it can persist for months or more, or metabolic activity can fluctuate over time. Eventually benignity was confirmed in these cases. These cases underscore the importance of interpretation with clinical context and awareness of chronological metabolic changes of mesenteric panniculitis to determine proper management.
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Verma P, Gujral S, Asopa RV. Spontaneous Resolution of Idiopathic Panniculitis: Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnosis and follow-up. INDIAN JOURNAL OF NUCLEAR MEDICINE : IJNM : THE OFFICIAL JOURNAL OF THE SOCIETY OF NUCLEAR MEDICINE, INDIA 2018; 33:248-249. [PMID: 29962727 PMCID: PMC6011554 DOI: 10.4103/ijnm.ijnm_42_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We present the case of a-55-year-old female patient who presented with dry cough. High-resolution computed tomography chest revealed multiple nodules in both lungs. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) was done to look for the unknown primary. It showed hypermetabolic bilateral lung nodules, subcutaneous nodules involving lower limbs, an intramuscular nodule, enlarged paratracheal, and right axillary nodes. There was no primary tumor seen. The biopsy of subcutaneous nodule revealed panniculitis with the foreign body granuloma. Follow-up scans after 6 and 9 months showed spontaneous resolution of all lesions except for few right axillary nodes. There was no active treatment given, and the patient remains asymptomatic on follow-up. Here, PET/CT played a role in excluding a primary tumor, guiding the biopsy, and follow-up.
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Affiliation(s)
- Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ramesh V Asopa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC, Mumbai, Maharashtra, India
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Kobayashi H, Notohara K, Otsuka T, Kobayashi Y, Ujita M, Yoshioka Y, Suzuki N, Aoyagi R, Ohashi R, Suzuki T. An Autopsy Case of Mesenteric Panniculitis with Massive Pleural Effusions. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:13-20. [PMID: 29298971 PMCID: PMC5763981 DOI: 10.12659/ajcr.905744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mesenteric panniculitis (MP) is an idiopathic chronic inflammatory condition of the mesentery. The main symptoms include abdominal pain, abdominal distention, weight loss, fever, nausea, and vomiting. The patients also present with chylous ascites in 14% of the cases and chylous pleural effusion (CPE) in very rare occasions. Despite the previous view of excellent prognosis of MP, two recent papers reported several fatal cases. However, there are still only a few autopsy case reports that describe the macroscopic and histological details of MP cases. CASE REPORT The patient was an 81-year-old Japanese woman. She complained of edema of her lower legs and face, general fatigue, and dyspnea. She was overweight and had type 2 diabetes (T2D). Computerized tomography (CT) demonstrated massive bilateral pleural effusions, with mild pericardial effusion and mild ascites. There was no pulmonary, cardiac or hepatic condition to explain the effusions. However, MP was suspected based on her CT. She gradually deteriorated into respiratory failure. The autopsy revealed CPEs (left 1,300 mL, right 1,400 mL) and MP in the mesentery of the small intestine. Neither neoplasia nor inflammatory conditions other than MP were detected. CONCLUSIONS In rare occasions, patients with MP present with CPE or chylothorax. We thought that a possible mechanism of the CPEs was a diaphragmatic defect. We suspected that being overweight and T2D had an etiological relationship with MP in our patient's case. Adipose tissue of the mesentery is the main focus of MP. We believed that MP would be the best umbrella term of the many synonyms.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kenji Notohara
- Department of Pathology, Kurashiki General Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Otsuka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuka Kobayashi
- Department of Oncology, Nagaoka Central Hospital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Naomasa Suzuki
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryuji Aoyagi
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Core Facility, Niigata University Faculty of Medicine, Niigata City, Niigata, Japan
| | - Toshimitsu Suzuki
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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Ueno M, Nishimura N, Shimodate Y, Doi A, Mouri H, Matsueda K, Yamamoto H, Mizuno M. Sclerosing mesenteritis diagnosed with computed tomography and ultrasound-guided needle biopsy: the utility of the coaxial technique. Clin J Gastroenterol 2017; 11:92-95. [PMID: 29143914 DOI: 10.1007/s12328-017-0800-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
Here we report a case of sclerosing mesenteritis that we diagnosed with needle biopsy under the guidance of computed tomography (CT) and ultrasound (US) observation. An 82-year-old woman presented with appetite loss, weight loss and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel and enlarged lymph nodes. Sclerosing mesenteritis was suspected, but malignancies, such as lymphoma, were also considered. We performed CT and US-guided needle biopsy with the coaxial technique. An introducer needle was inserted, its correct location was documented with CT, and multiple specimens were taken with a finer needle passed through the introducer without incident. Adequate specimens were obtained, and the histological diagnosis of sclerosing mesenteritis was made. We treated the patient with corticosteroids and her symptoms and the radiographic findings improved. The coaxial technique was a useful and minimally invasive tool for making the diagnosis of sclerosing mesenteritis.
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Affiliation(s)
- Masayuki Ueno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Naoyuki Nishimura
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hiroshi Yamamoto
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
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Tavares Pereira JP, Romão V, Eulálio M, Jorge R, Breda F, Calretas S, Leitão S, Eugénio G, Santos R, Carvalho A. Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:55-9. [PMID: 26848804 PMCID: PMC4743678 DOI: 10.12659/ajcr.896145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sclerosing mesenteritis is an idiopathic inflammatory and fibrotic disease that affects the mesentery. It is a rare disease, with the total number of reported cases in the literature ranging from 122 to 300. It mainly affects men in the sixth decade of life, and its etiology remains unknown. Clinical presentation is variable, but it is frequently asymptomatic. Diagnosis is often made by computed tomography (CT) scan, although biopsy may be needed for confirmation. An association between other diseases (e.g., neoplasms) and sclerosing mesenteritis has been described, but the relationship between the latter and glucose changes is not disclosed in the currently available literature. CASE REPORT Five cases of sclerosing mesenteritis and glucose metabolism disorders (impaired fasting glucose and type 2 diabetes mellitus) were retrospectively collected and analyzed. The mean age was 65 ± 9.3 years, 80% were male, and all patients were white. Three patients were asymptomatic and the other 2 (40%) had non-specific chronic abdominal pain. Blood tests revealed normal inflammatory parameters (mean HbA1c was 6.4% and fasting blood glucose was 140 mg/dL). The diagnosis was made by abdominal CT scan. The 2 symptomatic patients underwent therapy with colchicine 1 mg/day, with clinical improvement. During the mean 43-month follow-up period, there was no symptomatic progression, thereby maintaining the usual benign course of this condition. CONCLUSIONS Sclerosing mesenteritis has only been described in small series and isolated cases, but its diagnosis is becoming more common due to greater access to diagnostic methods and higher awareness of the disease in the medical community. Furthermore, despite the small sample size, we describe a possible association between glucose metabolism impairment and sclerosing mesenteritis.
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Affiliation(s)
| | - Vera Romão
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Eulálio
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rita Jorge
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Filipe Breda
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Suzana Calretas
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Leitão
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gisela Eugénio
- Department of Rheumatology, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Santos
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
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Rumman N, Rumman G, Sharabati B, Zagha R, Disi N. Mesenteric panniculitis in a child misdiagnosed as appendicular mass: a case report and review of literature. SPRINGERPLUS 2014; 3:73. [PMID: 25191632 PMCID: PMC4153878 DOI: 10.1186/2193-1801-3-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/31/2014] [Indexed: 12/21/2022]
Abstract
Mesenteric panniculitis is a chronic inflammatory process involving the adipose tissue of the mesentery. The etiology is unknown, and it is rare in children. We report a 5 year old girl who presented with abdominal symptoms and was misdiagnosed as appendicular mass. The correct diagnosis was established after surgical resection.
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Affiliation(s)
- Nisreen Rumman
- Department of Pediatrics, Makassed Hospital, Jerusalem, Palestine
| | - George Rumman
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
| | | | - Rami Zagha
- Department of Pathology, Al-Najah National University, Nablus, Palestine
| | - Nimer Disi
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
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