Mesenteric adenitis - MDTC evaluation in an Emergency Service

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1 Mesenteric adenitis - MDTC evaluation in an Emergency Service Poster No.: C-1885 Congress: ECR 2012 Type: Authors: Keywords: DOI: Educational Exhibit A. A. S. M. D. Santos, C. A. P. Fontes, M. H. Santos, M. R. Millar Neto, T. C. R. S. SANTOS, M. L. O. Santos, T. P. Vabo, V. F. Souza, A. B. S. G. Rosa; Niterói - Rio de Janeiro, RJ/BR Emergency, Abdomen, Lymph nodes, CT, Observer performance, Outcomes analysis, Perception image, Acute, Inflammation /ecr2012/C-1885 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Learning objectives The our objective was review the radiologic findings of mesenteric adenitis in multidetector computed tomography (MDCT) and describe the most important differential diagnosis. Background Acute abdominal pain, especially in the lower right quadrant, is a very common cause in children and young adults go to Emergency Services. Mesenteric adenitis is a self-limited benign inflammation of lymph nodes in the bowel mesentery characterized by fever, localized right lower quadrant abdominal pain, and frequent leukocytosis, making it difficult to differentiate from appendicitis and various acute abdominal injuries, being a non-surgical condition. With the use of multidetector computed tomography, the mesenteric adenitis is becoming an easy diagnosis to be done in the emergency department.if no other abnormality was detected on CT, then mesenteric adenitis was considered primary. If a specific inflammatory process was detected in addition to the lymphadenopathy, then mesenteric adenitis was considered secondary. When evidence of mesenteric adenitis is present on CT examinations, usually a specific diagnosis can be established as its cause. Imaging findings OR Procedure details We reviewed 25 cases of mesenteric adenitis attended in the emergency department and underwent MDCT for evaluation of acute abdominal pain. Mesenteric adenitis was considered present if a cluster of three or more mesenteric lymph nodes each measuring 5 mm or greater in short axis diameter was seen in the right lower quadrant, most commonly anterior to right psoas muscle, with a normal appendix identified. The differential diagnosis are: appendicitis, infectious enteritis, Crohn disease, intussusception, pseudomembranous colitis, ulcerative colitis, pelvic inflammatory disease and epiploic appendagitis. Images for this section: Page 2 of 9

3 Fig. 1: CT axial plane: Enlarged lymph nodes adjacent to the cecum. Page 3 of 9

4 Fig. 2: Coronal reconstruction of the same case demonstrating enhancement of enlarged lymph nodes adjacent to the cecum. Page 4 of 9

5 Fig. 3: 27 YEARS OLD. Nephrolithiasis and lumbar pain. Numerous lymph node at the root of the mesentery Page 5 of 9

6 Fig. 4: 11 YEARS OLD.Appendicitis? Mesenteric lymph nodes, the largest measuring 1.6 x 1.0 cm, pericecal. Fig. 5: 26 YEARS OLD. Suspected pyelonephritis. Mesenteric fat infiltration, lymphadenopathy associated with the ascending colon: mesenteric adenitis. Page 6 of 9

7 Fig. 6: 11 YEARS OLD. Appendicitis? Mesenteric lymph nodes, the largest measuring 1.6 x 1.0 cm, cecum. Page 7 of 9

8 Fig. 7: 35 years old. Densification of fat at the root of the mesentery. Fig. 8: 23 YEARS OLD. Abdominal pain. Mesenteric lymph nodes in the right iliac fossa enlarged, the largest with about 1.1 cm in its longest axis. Page 8 of 9

9 Conclusion The incidence of mesenteric adenitis in patients with abdominal pain is low. The finding of enlarged lymph nodes in the right lower quadrant in the context of the clinical presentation may lead the radiologist to suggest the diagnosis of primary mesenteric adenitis, thus allowing the patient to avoid undergoing surgery. Personal Information References 1. Pickhardt PJ; Bhalla S. Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics ;25(3):719-30, 2005 May-Jun. 2. Lucey BC; Stuhlfaut JW; Soto JA. Mesenteric lymph nodes seen at imaging: causes and significance.radiographics;25(2):351-65, 2005 Mar-Apr. 3. Carty HM. Paediatric emergencies: non-traumatic abdominal emergencies. Eur Radiol;12(12): , 2002 Dec. 4. Macari M; Hines J; Balthazar E; Megibow A. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR Am J Roentgenol;178(4):853-8, 2002 Apr. 5. Lee CC; Su CP; Chen SY; Chen SC; Chen WJ. Mesenteric adenitis caused by Salmonella enterica serovar Enteritidis. Formos Med Assoc;103(6):463-6, 2004 Jun. 6. Jelloul L; Frémond B; Dyon JF; Orme RL; Babut JM. Mesenteric adenitis caused by Yersinia pseudotuberculosis presenting as an abdominal mass. Eur J Pediatr Surg;7(3):180-3, 1997 Jun. 7. Lee JH; Rhee PL; Lee JK; Lee KT; Son HJ; Kim JJ; Koh KC; Paik SW; Lee WJ; Lim HK; Rhee JC. The etiology and clinical characteristics of mesenteric adenitis in Korean adults. J Korean Med Sci ;12(2):105-10, 1997 Apr. 8. Rao PM; Rhea JT; Novelline RA. CT diagnosis of mesenteric adenitis. Radiology;202(1):145-9, 1997 Jan. 9. Radin R. Acute mesenteric and retroperitoneal lymphadenitis in systemic lupus erythematosus: case report. Abdom Imaging ;26(4):411-3, 2001 Jul- Aug. 10. Christopher G. Anton. Mesenteric Adenitis. In Jeffrey RB at all. Diagnostic Imaging Emergency. Amirsys Ed. 2007: II:3-226 to 228. Page 9 of 9