History: 65 yo male with abdominal pain, nausea and vomiting
Solution: Sclerosing mesenteritis
Sclerosing mesenteritis is a complex mesenteric inflammatory process of unknown etiology. The imaging in this case identifies a coarsely calcified mass in the mesenteric root with some associated \"misty mesentery\". This is somewhat non-specific and a differential is appropriate in this case. Most likely alternative diagnoses would include carcinoid, lymphoma (treated), desmoid, and carcinomatosis.
There are some helpful imaging findings in this case that help you with the diagnosis. Carcinoid and desmoid both have retraction and desmoplastic reaction associated with them that is missing in this case. However, if the predominant process is fibrotic, retraction can also be seen with sclerosing mesenteritis. There is no other adenopathy and no history to suggest that this is treated lymphoma. There are no other areas of mesenteric involvement and no history to sugget that this is carcinomatosis. One imaging finding would be helpful if you identified it. On the second image, there is a mesenteric vessel traversing the left aspect of the mass. Around this vessel is a fat attenuation ring. This is called the \"Fat ring\" sign and is very suggestive of sclerosing mesenteritis. Regardless, definitive diagnosis requires biopsy.
This can occur at almost any age, but is most common in older patients. The process can be associated with a variety of non-specific inflammatory symptoms and if progressive can lead to complications related to obstruction of bowel, ureters, or mesenteric vessels. Treatment is typically anti-inflammatory medications, or surgery if the fibrosis is advanced.
Sclerosing mesenteritis is a complex mesenteric inflammatory process of unknown etiology. The imaging in this case identifies a coarsely calcified mass in the mesenteric root with some associated \"misty mesentery\". This is somewhat non-specific and a differential is appropriate in this case. Most likely alternative diagnoses would include carcinoid, lymphoma (treated), desmoid, and carcinomatosis.
There are some helpful imaging findings in this case that help you with the diagnosis. Carcinoid and desmoid both have retraction and desmoplastic reaction associated with them that is missing in this case. However, if the predominant process is fibrotic, retraction can also be seen with sclerosing mesenteritis. There is no other adenopathy and no history to suggest that this is treated lymphoma. There are no other areas of mesenteric involvement and no history to sugget that this is carcinomatosis. One imaging finding would be helpful if you identified it. On the second image, there is a mesenteric vessel traversing the left aspect of the mass. Around this vessel is a fat attenuation ring. This is called the \"Fat ring\" sign and is very suggestive of sclerosing mesenteritis. Regardless, definitive diagnosis requires biopsy.
This can occur at almost any age, but is most common in older patients. The process can be associated with a variety of non-specific inflammatory symptoms and if progressive can lead to complications related to obstruction of bowel, ureters, or mesenteric vessels. Treatment is typically anti-inflammatory medications, or surgery if the fibrosis is advanced.
CT Images
