Clinical diagnosis

Case 1

Mesenteric panniculitis

【Follow-up】
Because his symptom of diarrhea improved, no treatment prescribed. Three months later, the follow-up CT depicted the same radiological findings with no symptoms and the watchful observation was continued.

【Discussion】
Mesenteric panniculitis is reported to occur in teens to eighties with symptoms of abdominal pain, abdominal mass, fever or ileus-like symptoms of vomiting and abdominal fullness (1, 2). The onset location includes small-intestine mesentery, transverse-colon mesentery and sigmoid colon mesentery (1). In these days, a specimen of mesenteric panniculitis is documented to contain IgG4 component (3). However, it is controversial whether the mesentery panniculitis is relevant with IG4-related disease. Eighty percent of the reported cases in Japan underwent laparotomy for the purpose of digestive duct resection, artificial anal creation or biopsy (1). Twenty percent of those in Japan and most oversea cases underwent conservative treatments of antibiotics, low dose steroid or immune-suppressive agents (2, 4, 5,6).

【Summary】
A fourteen-year-old male came to our hospital for further investigation of abdominal mass detected by ultrasound. Non-enhanced CT and enhanced CT depicted densification of fat of the small-intestine-mesentery with preservation of the mesenteric vessels and with the fat halo sign (4-5) and the tumorous pseudocapsule sign (4-6). An image of diffusion MRI depicted a decrease of signal intensity of the lesion with the increase of b-values. The medical practitioner should recognize this rare disease with specific signs on abdominal CT since the surgical treatment can be avoidable.

【References】
1.Nihon Fukubu Kyukyu Igaku 2002: 22: 589-593 (Japanese)
2.J Clin Diagn Res. 2015 Dec; 9(12): PJ01. Published online 2015 Dec 1. doi: 10.7860/JCDR/2015/15533.6882
3.The Japanese Society of Gastroenterology, 48, archive.jsge.org/congress/detail/76853
4.Horton KM, Lawler LP, Fishman EK. Radiographics. 2003; 23(6):1561-7.
5.Gu GL, Wang SL, Wei XM, Ren L, Li DC, Zou FX. Cases J. 2008 Oct 16; 1(1):242. Epub 2008 Oct 16.
6.Ghanem N, Pache G, Bley T, Kotter E, Langer M. J Magn Reson Imaging. 2005 May; 21(5):632-6.

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