Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history

CT findings of idiopathic mesenteric panniculitis and analysis of related factors

OBJECTIVES

To analyze the computed tomography (CT) findings of idiopathic mesenteric panniculitis and the factors related to its characteristics and to improve the understanding of the disease.

METHODS

The imaging findings of 121 patients with mesenteric panniculitis were retrospectively analyzed, along with related factors such as age, sex, and abdominal visceral fat area.

RESULTS

Among the 121 patients, two had midgut malrotation, and the lesions were located outside the mesentery on the right side of the abdominal cavity, while the lesions in the other patients were located around the mesentery on the left side of the abdominal cavity, presenting as patchy or patchy fuzzy high-density masses. Annulus fibrosus and/or fatty ring signs were also observed in some patients. Scattered soft tissue nodules were observed around the mesentery in 119 patients. Eight patients had intestinal tract traction and retraction, and one patient had secondary intestinal obstruction. Nearly half of the patients had mesenteric vascular changes, and three had mesenteric vascular thrombosis. Among the 121 patients, there were 89 males and 32 females, aged 22-83, with an average age of 52.14 ± 13.53 years. The distribution range of abdominal visceral fat area (VFA) in 121 patients was 79.85-331.65 cm2.

CONCLUSION

Mesenteric panniculitis has certain characteristic imaging findings that can be accompanied by often ignored changes in the mesenteric blood vessels and intestinal tubes. Intestinal obstruction and mesenteric vascular thrombosis are rare complications, and their primary causes are often overlooked. Mesenteric panniculitis was correlated with sex, age, and VFA.

Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis

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.

Mesenteric Panniculitis Can Be Diagnosed by Examination and Cured by Comprehensive Therapy

Mesenteric panniculitis is a rare, slowly progressive, benign, and chronic fibrous inflammatory disease that affects the adipose tissue of the mesentery. In the present study, we aim to investigate its clinical presentations, computed tomography/sonography scan features, effectiveness of the treatment, and overall prognosis. We investigated various presentations, etiologies, diagnostic approaches, potential treatment modalities, and overall prognosis of mesenteric panniculitis. We present one case of mesenteric panniculitis with abdominal pain, which underwent steroid treatment regimens subsequently and gained weight moderately. An abdomen and pelvis cavity computed tomography scan showed misty mesentery, an ill-defined increase in the density of the peritoneal fat at the base of the mesentery with few small associated lymph nodes. The appearance is that of a panniculitis. His symptoms gradually decreased in intensity and disappeared totally within 1 month after oral prednisone 40 mg per day and moderate gain weight. Computed tomography scan features of the disease have recently been delineated clearly. Standard treatment strategy does not exist, and the current ways mainly consist of immunosuppressor or anti-inflammation agents. Overall prognosis is usually good and recurrence seems to be rare.

Relationship of mesenteric panniculitis with visceral and subcutaneous adipose tissue

Background/aim

Mesenteric panniculitis (MP) is an idiopathic benign disease characterized by fat necrosis, chronic inflammation, and fibrosis. The relationship between obesity and chronic low-grade inflammation has been reported. This study investigated the relationship of MP diagnosed using multidetector computed tomography (MDCT) with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas.

Materials and methods

We retrospectively enrolled 104 patients with no radiological findings other than MP. Additionally, 76 individuals without any indicative radiological findings were included as controls. VAT and SAT were separately calculated (cm2) using a 3-dimensional workstation. The abdominal circumference was measured (cm).

Results

The mean abdominal circumference was 99.9 ± 7.9 cm, SAT was 195.3 ± 89.1 cm2, and VAT was 203.9 ± 72.8 cm2 in the MP group. The abdominal circumference, VAT, and SAT were significantly higher in the MP group than in the control group (P < 0.001). According to the receiver operating characteristic (ROC) analysis, cut-off level VAT and SAT were 167.5 cm2 (sensitivity 71%, specificity 69%) and 117.5 cm2 (sensitivity 78%, specificity 51 %), respectively.

Conclusion

Increased VAT and SAT were associated with MP, suggesting their role in the etiology of MP.

Acute Recurrent Exacerbations of Mesenteric Panniculitis With Immunosuppressive Therapy: A Case Report and a Brief Review

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.

Clinical and radiological features of mesenteric panniculitis: a critical overview

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)

The Complex Relationship between Mesenteric Panniculitis and Malignancy - A Holistic Approach is Still Needed to Understand the Diagnostic Uncertainties

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.

A case of mesenteric panniculitis associated with metastatic poorly differentiated cancer of unknown primary site

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.

Mesenteric panniculitis: comparison of computed tomography findings in patients with and without malignancy

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.