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CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease
Karen M Horton1, Leo P Lawler, Elliot K Fishman
1Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Rm 3251, Baltimore, MD 21287, USA.
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.
Insights
Sclerosing mesenteritis is a rare inflammatory condition of the mesentery. Computed tomography (CT) aids diagnosis and distinguishes it from other mesenteric diseases, but biopsy is often needed.
Area of Science:
- Gastroenterology
- Radiology
- Pathology
Background:
- Sclerosing mesenteritis is a rare, idiopathic inflammatory disorder affecting the mesentery.
- It can be associated with other idiopathic inflammatory conditions.
- The exact cause remains unknown.
Purpose of the Study:
- To describe the computed tomographic (CT) findings of sclerosing mesenteritis.
- To highlight CT's role in differentiating sclerosing mesenteritis from other mesenteric pathologies.
- To discuss diagnostic and therapeutic approaches.
Main Methods:
- Review of CT imaging characteristics based on predominant tissue components (fat, inflammation, fibrosis).
- Comparison of CT features with other mesenteric diseases.
- Discussion of diagnostic confirmation via surgical biopsy and pathological analysis.
Main Results:
- CT appearance varies with dominant tissue components.
- CT can help differentiate sclerosing mesenteritis from conditions like carcinomatosis, lymphoma, and mesenteric edema.
- Surgical biopsy is often required for definitive diagnosis.
Conclusions:
- CT is crucial for suggesting sclerosing mesenteritis and excluding mimics.
- Diagnosis often requires pathological confirmation.
- Treatment options include medical therapy and, sometimes, surgical resection; CT with 3D volume rendering is optimal for follow-up.
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