Michael Leigh Wells MD, Presenter: Nothing to Disclose

Thomas Duncan Atwell MD, Abstract Co-Author: Nothing to Disclose

Jeff L. Fidler MD, Abstract Co-Author: Nothing to Disclose

John M. Barlow MD, Abstract Co-Author: Nothing to Disclose

Sudhakar Kundapur Venkatesh MD, FRCR, Abstract Co-Author: Nothing to Disclose

Patrick Wade Eiken MD, Abstract Co-Author: Nothing to Disclose

1) A “misty” or infiltrative appearance of the mesentery may be due to multiple etiologies with considerable variation in clinical management; categories include hemorrhage, edema, lymphatic fluid, protein, fibrosis, inflammation, and tumor (“HELPFIT”). 2) Clinical history and additional findings such as lymphadenopathy, solid mass or abnormalities of the abdominal organs will help to narrow the differential diagnosis.  

Intro -Definition of imaging findings and general categories of disease Categories and case examples Hemorrhage: Trauma, aneurysm Edema   General: Anasarca, cirrhosis, nephropathy, hypoalbuminemia   Local: Bowel obstruction, venous thrombosis, arterial embolism/dissection, vasculitis, radiation Lymphatic: Lymphatic obstruction, lymphangiectasia, lymphangioma, lymphangiomatosis Protein: Amyloidosis Fibrosis: Fibromatoses Inflammatory infiltration:    Pancreatitis, appendicitis, diverticulitis   Sclerosing mesenteritis, pseudotumor, IgG4, sarcoidosis, celiac sprue, erdheim-chester   Tuberculosis Tumor: Lymphoma, metastatic disease, plexiform neurofibroma, mesothelioma, castlemans disease, lipoma, myolipoma, liposarcoma Conclusion -An infiltrative or “misty” appearance of the mesentery has a differential diagnosis which can be sufficiently narrowed using additional pertinent imaging findings.  

http://abstract.rsna.org/uploads/2014/14003974/14003974_cx8j.pdf

Wells, M, Atwell, T, Fidler, J, Barlow, J, Venkatesh, S, Eiken, P, Infiltrative Disease of the Mesentery: Beyond the Misty Mesentery.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003974.html