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Il Giornale Italiano di Radiologia Medica 2018 Gennaio-Febbraio;5(1):41-7

DOI: 10.23736/S2283-8376.17.00016-X


language: Italian

Clinico-radiological features of mesenteric panniculitis

Giuseppe BURAGINA 1 , Gaia SPADARELLA 1, Francesca RIGIROLI 1, Luca A. CARBONARO 2, Pierpaolo BIONDETTI 1, Gianpaolo CARRAFIELLO 3, Alberto MAGENTA BIASINA 3

1 Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italia; 2 Unità Operativa di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italia; 3 Unità Operativa di Radiologia Diagnostica e Interventistica, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Paolo, Milano, Italia


BACKGROUND: Mesenteric panniculitis is a rare form of inflammation that mainly involves the mesenteric adipose tissue. The etiology remains unknown and the disease has been associated with various conditions such as cancer, abdominal trauma, previous surgery, autoimmune diseases and obesity. Mesenteric panniculitis can be divided into two main groups: the classic form of mesenteric panniculitis, constituted by inflammation and degeneration of the mesenteric fat, and the retractile panniculitis, mainly fibrotic, with retraction of the surrounding structures. From a radiological point of view, in the scientific literature, there are two main signs: the “fat ring sign”, which is the presence of normal, not-inflamed fat around vessels and lymph nodes, and the pseudo-capsule around the lesion.
METHODS: Our study includes 544 cases of mesenteric panniculitis, diagnosed on computed tomography (CT) and magnetic resonance imaging (MRI) images, based on the presence of: 1) increased mesenteric fat density on CT images or a change of mesenteric fat intensity on MRI images, with mass effect on the surrounding structures; 2) the presence of vessels and lymph nodes within the lesion; 3) the presence of the two main indicative radiological signs of the disease, the “fat ring sign” and the pseudo-capsule surrounding the lesion; 4) the presence of an important fibrotic component, causing retraction of the surrounding structures, to define the retractile form.
RESULTS: From a clinical point of view we have observed a strong association with neoplasms, especially of the gastrointestinal tract, previous surgery and other abdominal disorders such as urinary lithiasis or inflammatory diseases.
CONCLUSIONS: To date, mesenteric panniculitis is an unhealthy pathology, occasionally diagnosed especially in CT examinations performed for other reasons. In addition, the number of studies regarding the MRI aspects of this pathology is very limited. The purpose of our study is therefore to provide a detailed radiological description of both CT and MRI features of mesenteric panniculitis with reference to the related clinical conditions.

KEY WORDS: Panniculitis, peritoneal - Neoplasms - Inflammation - Tomography, X-ray computed - Magnetic resonance imaging

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