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

Zusammenfassung

Hintergrund Bei einer Panniculitis mesenterialis (PM) handelt es sich um eine unspezifische, chronische Veränderung des mesenterialen Fettgewebes unklarer Ätiologie. Sie ist bevorzugt bei Männern und häufig im mittleren bis höheren Erwachsenenalter anzutreffen. Die PM wird in der Regel als Zufallsbefund im Rahmen einer abdominellen CT-Untersuchung festgestellt.

Methoden Es wurde eine umfassende Literaturrecherche in PubMed durchgeführt, bei der Fallberichte und Kohortenstudien einer systematischen Betrachtung unterzogen wurden. Schlüsselwörter waren (und/oder) „Mesenteric Panniculitis“, „Panniculitis mesenterialis“, „mesenteric lymph nodes“, „CT“, „imaging“, „sclerosing mesenteritis“, „case report“, „therapy“.

Ergebnisse und Schlussfolgerung Die PM kommt relativ häufig vor, bleibt jedoch oft im CT-Befund unerwähnt. Somit ist von einer größeren Prävalenz als den berichteten 0,6 bis 2,4 % auszugehen. Die wichtigste, mitunter schwer abzugrenzende Differentialdiagnose, ist das maligne Lymphom. In der Mehrzahl der Fälle bleibt die PM asymptomatisch, selten ist sie Ursache für ein unspezifisches klinisches Erscheinungsbild u. a. mit Bauchschmerzen, Fieber, Erbrechen oder Übelkeit. In äußerst seltenen Fällen besteht eine Therapieindikation; in der Literatur wird hauptsächlich der Einsatz von Glukokortikoiden und Tamoxifen beschrieben. In der Vergangenheit wurde häufig die These vertreten, eine PM sei mit verschiedenen Erkrankungen assoziiert bzw. ein paraneoplastisches Phänomen. Vier kürzlich publizierte Studien mit Fall-Kontroll-Design kommen jedoch zu dem Schluss, dass es sich bei der PM um eine unspezifische, benigne Veränderung handelt. Zwei weitere Studien weisen wiederum auf eine mögliche Assoziation mit malignen Lymphomen hin. Der klinische Stellenwert der PM bleibt somit weiterhin Gegenstand wissenschaftlicher Diskussionen.

Kernaussagen: 

• Die Panniculitis mesenterialis (PM) ist eine unspezifische, chronische Entzündung des mesenterialen Fettgewebes mit charakteristischen Zeichen im CT.

• Die PM stellt häufig einen CT-Zufallsbefund dar

• Die wichtigste Differentialdiagnose ist das maligne Lymphom

• Eine Assoziation mit anderen und insbesondere malignen Erkrankungen wird diskutiert, lässt sich jedoch nicht eindeutig nachweisen

• Die PM wird äußerst selten klinisch symptomatisch, wenn dann mit z. B. Fieber, Übelkeit, Erbrechen, Bauchschmerzen

Key words

abdomen - CT - mesentery - inflammation - lymphoma - paraneoplastic phenomenon

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