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Abdominal CT demonstrates a 7x4x4 cm stellate soft tissue mass (arrow) in the root of the mesentery with numerous tentacles extending from the mass to the mesentery. Desmoplastic reaction is evident (arrows). Thickening of multiple loops of the small bowel is also visible.
On CT, mesenteric panniculitis may be suggested by increased attenuation of mesentery, variable soft tissue nodular, cystic, or infiltrative densities of mesenteric fat, calcification (due to fat necrosis), or iodinated contrast enhancement. This enhancement can differentiate mesenteric panniculitis from lymphoma or liposarcoma, which typically do not enhance.
MR may be useful to demonstrate the extent of the mass or to evaluate the relationship of the mass to the mesenteric artery or vein. Kinking or tethering of the small bowel may also be observed. T1 demonstrates intermediate signal intensity with strands radiating from the mass, while T2 demonstrates heterogeneous signal intensity, dependent on presence of calcification and the extent of inflammatory components and residual fat. Low signal intensity on T2 may distinguish this condition from malignant tumors.
Spontaneous remission is the most common outcome of this condition. Corticosteroids and immunosuppressants can relieve symptoms in particularly aggressive cases. Surgical resection is reserved to bypass an obstructed bowel or for palliation of symptoms.
