Mesenteric Panniculitis (MP): A Frequent Coincidental CT Finding of Debatable Clinical Significance

Abstract

Background: Mesenteric panniculitis (MP) is histologically characterized by chronic nonspecific inflammation of the adipose tissue of the intestinal mesentery with unclear etiology. MP occurs predominantly in men, mostly in mid to late adulthood. MP is typically found as an incidental diagnosis on abdominal CT.

Methods: A comprehensive review of the literature including case reports and cohort studies was performed. Therefore, a global search in PubMed was carried out. Search terms were (and/or) "mesenteric panniculitis", "panniculitis mesenterialis", "mesenteric lymph nodes", "CT", "imaging", "sclerosing mesenteritis", "case report", "therapy".

Results and conclusion: MP is a relatively common CT finding. The true prevalence seems to be higher than the reported 0.6 % to 2.4 % due to underreporting. The most important differential diagnosis is malignant lymphoma, which may be difficult to distinguish from MP. The majority of patients with MP are clinically asymptomatic and do not require therapy. In rare symptomatic cases, non-specific symptoms like abdominal pain, fever, nausea or vomiting occur. For therapy, glucocorticoids and tamoxifen have been suggested. Several studies suggested that MP is associated with other diseases and might be a paraneoplastic phenomenon, but four recently published case-control studies suggest that MP is an independent non-specific benign age-related phenomenon. However, two further studies show a possible association of MP with malignant lymphoma. The clinical relevance of MP remains the subject of scientific debate.

Key points: · Mesenteric panniculitis (MP) is a non-specific, chronic inflammation of the mesenteric adipose tissue with characteristic CT signs. · MP is a relatively common incidental finding on abdominal CT. · Malignant lymphoma is the main differential diagnosis. · An association of MP with other diseases including malignancy has been discussed but cannot be confirmed unequivocally. · MP is rarely symptomatic with fever, nausea, vomiting, abdominal pain, or diarrhea.

Citation format: · Gögebakan Ö, Osterhoff MA, Albrecht T. Mesenteric Panniculitis (MP): A Frequent Coincidental CT Finding of Debatable Clinical Significance. Fortschr Röntgenstr 2018; 190: 1044 - 1052.