Monday, September 19, 2011

Calcified Mesenteric Masses: Differential Diagnosis

  • Calcified metastatic implants: Ovarian carcinoma, mucinous colon carcinoma, or gastric carcinoma.
  • Carcinoid: Enhancing soft-tissue mass with surrounding radiating bands (fibrotic proliferation and desmoplastic reaction due to serotonin). 70% contain calcifications. Adjacent small bowel loops can be thickened (due to tumor infiltration or ischemia) or angulated.
  • Chronic sclerosing mesenteritis (shown above): Sclerosing mesenteritis is a rare inflammatory condition that affects the fat at the root of the mesentery with variable amounts of inflammation, fatty necrosis, and fibrosis. The chronic phase is also known as retractile mesenteritis and is characterized by fibrosis and a soft-tissue mass, with or without dystrophic calcifications.
  • Amyloidosis: An unusual presentation of systemic amyloidosis is one with mesenteric and/or omental infiltration, typically with coarse dystrophic calcifications.
  • Peritoneal echinococcosis: Almost always due to hepatic involvement and subsequent seeding from spontaneous or iatrogenic rupture. Suggestive features are cysts with calcific rims.


  • Pickhardt PJ, Bhalla S. Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics. 2005 May-Jun;25(3):719-30.
  • Sheth S, Horton KM, Garland MR, Fishman EK. Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics. 2003 Mar-Apr;23(2):457-73.


  1. Please see this reference to calcified mesenteric lymph nodes from Mettler, a respected radiologist and author found on the internet.

    You left out the most important cause of mesenteric lymph node calcification, although, of course, this is without a mass.

    "Calcification of mesenteric lymph nodes can occur as a result of previous infections. These are usually seen as somewhat rounded or popcorn-shaped calcifications in the right midabdomen. A tip-off is the significant downward movement of these calcifications on the upright views, because the mesentery is very mobile (Fig. 6–14)."

    "Figure 6-14 Calcification in the mesenteric lymph nodes. This is a benign finding. The calcifications are typically located in the midabdomen to the right of midline, are somewhat popcorn shaped (arrow), and are relatively easy to see on a supine KUB (A). On an upright view of the abdomen (B), these calcifications drop substantially, owing to the mobility of the mesentery."

  2. Thanks so much for writing. I didn't include calcified lymph nodes, atherosclerosis, and pancreatic saponification, as I didn't consider them to be masses. You may want to check out a related post on mesenteric calcifications.


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