Misty mesentery : Mesenteric panniculitis and associated processes

Abstract

Sclerosing mesenteritis (SM) and mesenteric panniculitis are rare processes of the mesentery which pose amajor clinical and imaging challenge. This review article attempts to introduce asystematic nomenclature to address typical symptoms, imaging and major differential diagnoses. SM with its subtypes-mesenteric lipodystrophy, panniculitis and retractile mesenteritis-is achronic process with avery diverse and heterogeneous clinical appearance. The typical radiological characteristics ("misty mesentery", increased lymph nodes, pseudocapsule and "fat halo") are also not very specific. Alink between SM and malignant diseases is not proven, but there is controversial discussion. Therefore, if there are doubts about the diagnosis, further examinations and abiopsy are desired. When diagnosing SM, "red flags", i. e. characteristics that are atypical for SM in imaging, should be considered. In case of ambiguous imaging, differential diagnostics should also consider malignant diseases and exclude them.