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F-18 FDG PET Demonstration of Sclerosing Mesenteritis

Nguyen, Ba D. MD

Original Articles

Sclerosing mesenteritis is a rare, combined inflammatory and fibrotic process of unknown etiology. Detailed cross-sectional imaging of this entity has been reported with computed tomography. The author presents an additional case of sclerosing mesenteritis demonstrated on fluorine-18 fluorodeoxyglucose positron emission tomography with multidetector computed tomographic correlation.

clerosing mesenteritis (SM) is also known as retractile mesenteritis, mesenteric panniculitis, mesenteric lipodystrophy, xanthogranulomatous mesenteritis, sclerosing lipogranulomatosis, and mesenteric Weber-Christian disease (Fig. 1). All these different names probably represent the same clinical entity with different degrees of fibrosis, inflammation, and fat necrosis. 1 SM of unknown etiology and pathogenesis is seen frequently in the fifth or sixth decade of life, with a male-to-female ratio of 2:1. A large spectrum of nonspecific gastrointestinal clinical manifestations is encountered, ranging from abdominal pain to bowel obstruction. Computed tomography shows an enhancing mesenteric mass with compression, distortion, and encasement of adjacent bowel loops and mesenteric vessels. 2

Additional computed tomographic features may include low-attention foci representing fat necrosis and fibrosis, and the “fat ring” sign and tumoral pseudocapsule related to the inflammatory component of SM. 2 These computed tomographic features are, however, not specific for SM and may be encountered with lymphoma, carcinoid, desmoid tumor, or other malignancy involving the mesentery. SM diagnosis is reached with histopathology through biopsy or excision. Therapy for SM includes surgery to debulk the tumor in case of bowel obstruction and vessel compromise, and medical treatment such as corticosteroids, colchicine, immunosuppressive drugs, and progesterone. 3–7 In the presented case, the doughnut-shaped pattern of fluorodeoxyglucose uptake of the mesenteric mass probably represents the 2 components of SM: peripheral high metabolic inflammation and inactive central area of fibrosis or sclerosis.

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From the Department of Radiology, Mayo Clinic Scottsdale, Arizona.

Correspondence to: Ba D. Nguyen, MD, Department of Radiology, Mayo Clinic Scottsdale, 13400 E. Shea Boulevard, Scottsdale, AZ 85259. E-mail: nguyen.ba@mayo.edu.Received for publication December 30, 2002. Accepted February 13, 2003.

© 2003 Lippincott Williams & Wilkins, Inc.