Mesenteric Panniculitis

Mesenteric panniculitis is chronic inflammation of the mesenteric fat. The etiology of mesenteric panniculitis is unclear, but it has been linked to vasculitis, granulomatous disease, rheumatic disease, malignancy, and pancreatitis.

Mesenteric panniculitis may be complicated by fibrosis and retraction, at which point it is referred to as mesenteric fibrosis.

CT findings of mesenteric panniculitis include:

• A well-circumscribed heterogeneous fatty mass: Usually extends from the mesenteric root towards the jejunum. A high-attenuation stripe may partially surround the mass (tumoral pseudocapsule).
• Higher attenuation of the involved fat: Also known as segmental misty mesentery
• Well-defined nodules: Soft-tissue density nodules less than 5 mm in diameter. May have a low-attenuation halo.
• Fat ring sign: Preservation of the low fat attenuation surrounding mesenteric vessels.

Patients may present with progressive or intermittent symptoms, including a palpable abdominal mass, as well as systemic manifestations such as abdominal pain, pyrexia, weight loss, and bowel disturbance

References

• Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, Gourtsoyiannis N. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol. 2000 Feb;174(2):427-31.
• Seo BK, Ha HK, Kim AY, Kim TK, Kim MJ, Byun JH, Kim PN, Lee MG, Yang SK, Yu ES, Kim JH. Segmental misty mesentery: analysis of CT features and primary causes. Radiology. 2003 Jan;226(1):86-94.