Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up

Abstract

Objective: To determine prevalence, clinicoradiological characteristics and outcome of patients with mesenteric panniculitis (MP) in a large hospital-based population.

Methods: Consecutive abdominal CT examinations of 3820 patients were evaluated for MP. Clinical characteristics, therapy and outcome of patients with MP were evaluated during a 5-year follow-up period. A matched pair analysis was performed to further investigate the relation between MP and malignancy.

Results: 94 (2.5%) patients with MP were identified (mean age, 66.6 ± 11.2 years, 70.2% male). MP coexisted with malignancy (especially prostatic carcinoma) in 48.9% of patients, and this was slightly but significantly higher than in age- and sex-matched control patients (n = 188, 46.3%). In 48 patients, MP was presumed to be idiopathic. The most frequent presenting symptom was pain (54.3%). Laboratory findings revealed increased acute-phase reactants in half of the patients with MP. CT findings included increased density of mesenterial fat (mean, -56.8 ± 10.8 HU), fat ring sign, tumoural pseudocapsule and small soft-tissue nodules. Patients with MP (14.6%) developed significantly more malignancies during a 5-year follow-up than did the control group (6.9%). One patient was treated with prednisone without satisfactory response.

Conclusion: The prevalence of MP in this study was 2.5%. In most patients, radiologic features included increased mesenteric fat density, fat ring sign and small soft-tissue nodules. MP was associated with a significant higher prevalence of coexisting malignancies and a higher prevalence of future cancer development.

Advances in knowledge: A more accurate prevalence of MP on CT is demonstrated. An underlying malignancy may play a role.

Figure 1.

(a, b) Mesenteric panniculitis: the mesenteric fat is hyperdense compared with the subcutaneous or retroperitoneal fat and displaces the surrounding small bowel loops.

Figure 2.

Mesenteric panniculitis with the characteristic “fat-ring” sign (arrow). The mesenteric vessels, which are surrounded by normal fat, are enveloped by hyperdense mesenteric fat.

Figure 3.

Mesenteric panniculitis with “tumoural pseudo-capsule” (arrow), a dense stripe in the peripheral region differentiating normal mesentery from the inflammatory process.