J Korean Soc Radiol.  2019 Nov;80(6):1091-1106. 10.3348/jksr.2019.80.6.1091.

Mesenteric Lesions with Similar or Distinctive Appearances on CT

• Cha H
• Hwang J
• Hong SS
• Lee EJ
• Kim HJ
• Chang YW

• KMID: 2464909
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1091

Abstract

The mesentery is a structure comprising a double peritoneal layer that attaches the bowel to the abdominal wall. Mesenteric disease can cause various non-specific clinical symptoms in adults and is sometimes found incidentally during unrelated diagnostic imaging studies. CT plays an essential role in the diagnosis of mesenteric disease, which can present with various radiologic features, including a solid mass, cystic mass, or local or diffuse infiltration on CT. Some mesenteric diseases present with distinctive characteristics, while others share similar findings, thereby complicating their differential diagnosis. Therefore, understanding the radiological findings of mesenteric disease is important for accurate diagnosis and appropriate treatment.

MeSH Terms

Abdominal Neoplasms
Abdominal Wall
Adult
Diagnosis
Diagnosis, Differential
Diagnostic Imaging
Humans
Mesentery
Tomography, X-Ray Computed

Figure

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  Fig. 1. Desmoid tumor in a 52-year-old man with a past history of an operation performed 7 years ago. A, B. The contrast-enhanced axial CT image shows a homogeneous soft-tissue mass with a poorly defined border in the pelvic mesentery (A), showing interval growth on a follow-up scan performed 3 months later (B) (arrows).

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  Fig. 2. Immunoglobulin G4-related sclerosing mesenteritis in a 78-year-old woman. A, B. The contrast-enhanced axial and coronal CT images show an irregular and heterogeneous soft-tissue mass in the small bowel mesentery with an intralesional mesenteric vessel (empty arrow in A) and calcifications (arrows in A). The adjacent small intestine shows mild mural thickening, representing small bowelischemia (arrowheads in A and B).

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  Fig. 3. Sclerosing mesenteritis in a 68-year-old woman. The contrast-enhanced axial CT image shows an illdefined soft-tissue mass in the small bowel mesentery with the fatring sign (arrows).

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  Fig. 4. Intestinal neuroendocrine tumor in a 47-year-old man. A. The contrast-enhanced axial CT image shows an enhancing soft-tissue mass with focal strands radiating in the mesenteric fat (arrow). B. A well-defined hypervascular enhancing mass (arrow) is seen in the ileum, indicating the primary intestinal neuroendocrine tumor.

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  Fig. 5. Paraganglioma in a 64-year-old man. A. The contrast-enhanced axial CT image shows a well-marginated enhancing mass with internal low-attenuation areas (arrow). B. The internal low-attenuation areas show hyperintensity on the axial T2-weighted MR image (arrow).

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  Fig. 6. Leiomyoma in a 49-year-old woman. A. The contrast-enhanced coronal CT image shows a well-defined enhancing soft-tissue mass with a central low-attenuation area in the right lower abdominal mesentery (arrow). Uterine subserosal leiomyomas (arrowheads) are seen, which show similar attenuation and enhancement to that of the mesenteric mass. B. On the axial T2-weighted MR image, the mesenteric mass shows a similar low signal intensity to that of the smooth muscle (arrow).

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  Fig. 7. Extragastrointestinal gastrointestinal stromal tumor in a 62-year-old man. The contrast-enhanced axial CT image shows a large, well-defined heterogeneous mass with central necrosis or cystic change in the greater omentum. A well-defined cystic massoriginating from the omentum and adhering to the gastric wall was found on surgery.

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  Fig. 8. Plexiform neurofibroma in a 21-year-old woman with neurofibromatosis type 1. The contrast-enhanced coronal CT image shows a branchingor coalescent, homogeneously low-attenuation mass at the porta hepatis, periceliac area, and mesentery, encasing the portal veins, celiac trunk, and mesenteric vessels.

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  Fig. 9. Cystic lymphangioma in a 69-year-old man with abdominal distension and discomfort. The contrast-enhanced axial CT image shows large, thin-walled, multilobulated cysts inthe right abdominal mesentery. The mesenteric vessels are seen coursing between the cystic locules (arrows).

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  Fig. 10. Cystic mesothelioma in a 64-year-old man. The contrast-enhanced axial CT image shows a grape-like cluster of thin-walled cysts. A space-occupying low-density cystic lesion is seen in the right abdominal mesentery. The cystic lesion does not pres-ent a mass effect on the adjacent bow-el (arrow).

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  Fig. 11. Cavernous hemangioma in a 56-year-old woman. The contrast-enhanced axial CT image shows a poorly-defined soft-tissue mass with multiple phleboliths (arrows). Themass does not invade the adjacent organs in the left lower abdominal mesentery.

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  Fig. 12. Tuberculous lymphadenitis with enteritis in a 50-year-old man with active pulmonary tuberculosis and pleurisy. A, B. The contrast-enhanced coronal CT images show multiple enlarged lymph nodes with central low-attenuation necrosis and peripheral contrast enhancement in the right lower abdominal mesentery (arrows in A). Segmental mural thickening of the distal ileum is noted (arrow in B). Mycobacterium tuberculosis was confirmed on the culture test and on acid-fast bacilli staining of an endoscopic biopsy specimen.

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  Fig. 13. Sarcoidosis in a 37-year-old man. A. The contrast-enhanced axial CT images show homogeneously enhancing, enlarged lymph nodes in the mesentery. B. Diffuse mural wall thickening of the stomach is also seen. Sarcoidosis was pathologically proven on an endoscopic stomach biopsy test.

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  Fig. 14. Extranodal marginal zone B-cell lymphoma of the mucosa-asso-ciated lymphoid tissue in a 52-year-old woman. The contrast-enhanced axial CT image shows a homogeneously enhancing mass indicating conglom-erated lymphadenopathy, which encases the mesenteric vessels withoutany caliber change, i.e., the so-called “sandwich sign” (arrow).

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  Fig. 15. Tuberculous peritonitis in a 54-year-old woman. The contrast-enhanced axial CT image shows a large amount of ascites with smooth and symmetric thickening and contrast enhancement of the peritoneum, which is a relatively characteristic feature of tuberculous peritonitis. The omentum has a smudged or dirty appearance (arrows).

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  Fig. 16. Gastric cancer with peritoneal carcinomatosis in a 39-year-old man with abdominal pain and weight loss. A, B. The contrast-enhanced axial CT images show nodular omental infiltration (asterisks in A) and irregular thickening of the peritoneum with moderate amount of ascites. Note the enhancing wall thickening with ulceration in the gastric body, representing the primary gastric cancer (arrow in B).

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  Fig. 17. Refractory peripheral T-cell lymphoma with peritoneal lymphomatosis in a 63-year-old man with unsuccessful chemotherapy. A, B. The contrast-enhanced axial CT images show enlarged lymph nodes in the retroperitoneum (arrows inA) and multifocal bowel wall thickening (arrowheads in A). Irregular thickening of the peritoneum with ascites is also observed (arrows in B).

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  Fig. 18. Malignant mesothelioma in a 44-year-old man. A-B. The contrast-enhanced axial CT images show a large amount of ascites, nodular thickening of the peritoneum (arrows in A), and enhancing masses in the mesentery (arrowhead in A) and pelvis (arrow in B), which are findings of “wet-type” malignant mesothelioma.

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  Fig. 19. Smooth muscle tumors with uncertain malignant potential in a 28-year-old woman. A, B. The contrast-enhanced axial CT images show multiple well-circumscribed, strong-enhancing masses in the paracolic gutter (arrow in A), pelvic cavity (arrows in B), and uterus (asterisks in B). These lesions arenot diagnosable from leiomyomas on the basis of imaging findings.

Reference

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