Mesenteric Panniculitis
Retractile Mesenteritis

General Considerations

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

Clinical Findings

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

Imaging Findings

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

Differential Diagnosis

• Lymphoma
• Desmoid tumor
• Carcinoid

Treatment

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

Complications

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

Prognosis

• Excellent

Mesenteric Panniculitis. White arrows point to strand-like infiltration of the small bowel mesentery producing a haziness called the misty mesentery sign. The blood vessels are surrounded but not displaced. There are no enlarged nodes seen.
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General Case of the Day.  Patel, N; Saleeb, S; Teplick, S. RadioGraphics. 1999;19:1083-1085.

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

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