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MESENTERICAL PANNICULITIS

Last updated: November 6, 2025

Main reference: CAR 2025

Follow up with a CT scan of the neck and chest and/or an abdominopelvic CT scan in 6 months.

  • If lymph node > 10 mm in short axis or other lymphadenopathy outside the mesentery (including retroperitoneum) or

  • History of neoplastic disease or clinical suspicion of neoplastic disease

Otherwise, no additional follow-up is necessary.

General Information

  • Other terms for mesenteric panniculitis

    • Sclerosing mesenteritis

    • Retractile mesenteritis

    • Mesenteric lipodystrophy

    • Mesenteric fibrosis

  • Chronic and idiopathic inflammation of the mesenteric fat

  • Potential etiology: trauma, surgery, autoimmune disease, cancer, mesenteric ischemia

  • Prevalence: 0.16 - 7.8%

  • Man: woman = 2:1

  • Generally among 50-70 year olds

Symptoms

  • Asymptomatic

  • Abdominal pain, especially in the flanks (30-70%)

  • Systemic symptoms: fever, malaise, weight loss (20-23%)

  • Nausea, vomiting, bowel changes (25%)

  • Palpable mass

  • Duration of symptoms: 3 weeks to 2 years

  • Rarely do patients present with bowel obstruction or debilitating chronic symptoms requiring surgery or medical intervention (e.g., anti-inflammatory)

Imaging

CT

  • Mesenteric fat infiltration

    • Often with pseudocapsule and lymph nodes

    • Ships passing through this infiltration zone are intact.

  • If the subtype is predominantly fibrosing (retractile mesenteric): fibrosis and retraction of the intestines and mesenteric vessels

    • Increased risk of obstruction

    • Possible submucosal edema secondary to sheathing or vascular thrombosis

    • +/- Ca++

MRI

  • Fat infiltration is hypointense on T1/T2 and hyperintense on T2FS.

  • No restrictions on distribution

Differential diagnosis

  • Lymphoma

    • The fat-ring sign (preservation of normal fat around blood vessels) is not a reliable sign of a benign process.

    • PET scan

      • If negative: high certainty of a benign lesion

      • If positive: does not allow differentiation between a benign vs. malignant process

  • Carcinoid and desmoid

    • To be considered if fibrosing type

    • Especially if Ca++

    • Suggest biopsy

References

Bird JR, Brahm GL, Fung CI, Tu W, Zheng IJ, Kirkpatrick IDC. CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults. Can Assoc Radiol J. 2025 Jun 25:8465371251346732. doi:10.1177/08465371251346732.

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