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Mesenteric Adenitis

CT Diagnosis of Primary Versus Secondary Causes, Incidence, and Clinical Significance in Pediatric and Adult Patients

Michael Macari1, John Hines, Emil Balthazar and Alec Megibow

1 All authors: Department of Radiology, Abdominal Imaging, NYU Medical Center, Tisch Hospital, 560 First Ave., Ste. HW 206, New York, NY 10016.



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  		Fig. 1A. —Primary mesenteric adenitis in 27-year-old woman with right lower quadrant pain. Axial CT scan obtained with IV and oral contrast material at level of upper pelvis shows cluster of lymph nodes (arrow) in right lower quadrant mesentery.

 


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  		Fig. 1B. —Primary mesenteric adenitis in 27-year-old woman with right lower quadrant pain. Axial CT scan obtained at level of terminal ileum (arrow) and cecum shows minimal wall thickening. Appendix was also normal (not shown). Patient improved on antibiotic therapy.

 


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  		Fig. 2. —Primary mesenteric adenitis in 27-year-old woman with right lower quadrant pain. Axial CT scan obtained with IV and oral contrast material at level of upper pelvis shows cluster of lymph nodes (arrows) in right lower quadrant mesentery. Appendix and terminal ileum (not shown) were normal. Patient was discharged from emergency department and improved without therapy.

 


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  		Fig. 3A. —Secondary mesenteric adenitis in 14-year-old girl with right lower quadrant pain and appendicitis. Axial CT scan obtained with IV and oral contrast material at level of upper pelvis shows cluster of lymph nodes (arrows) in right lower quadrant mesentery.

 


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  		Fig. 3B. —Secondary mesenteric adenitis in 14-year-old girl with right lower quadrant pain and appendicitis. Axial CT scan obtained at level of appendix shows dilated, fluid-filled appendix (arrow) with enhancing wall. Surgery confirmed appendicitis.

 


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  		Fig. 4A. —Secondary mesenteric adenitis in 29-year-old man with right lower quadrant pain and Crohn's disease. Axial CT scan obtained with IV and oral contrast material at level of upper pelvis shows cluster of lymph nodes (arrow) in right lower quadrant mesentery.

 


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  		Fig. 4B. —Secondary mesenteric adenitis in 29-year-old man with right lower quadrant pain and Crohn's disease. Axial CT scan obtained at level of previous small-bowel anastomosis shows thickening of small bowel and stranding of mesenteric fat (arrow) consistent with recurrent Crohn's disease.

 


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  		Fig. 5A. —Secondary mesenteric adenitis in 34-year-old woman with right lower quadrant pain and ascending colonic diverticulitis. Axial CT scan obtained with IV and oral contrast material at level of upper pelvis shows cluster of lymph nodes (long arrows) in right lower quadrant mesentery. Note normal contrast material—filled appendix (short arrow).

 


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  		Fig. 5B. —Secondary mesenteric adenitis in 34-year-old woman with right lower quadrant pain and ascending colonic diverticulitis. Axial CT scan obtained at level of ascending colon shows inflamed diverticulum (solid arrow) and stranding of fat around ascending colon. Several small lymph nodes (open arrow) are also identified. Patient was treated for right-sided diverticulitis and improved on antibiotic therapy.

 


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  		Fig. 6A. —Mesenteric adenitis in 25-year-old man with right lower quadrant pain. Axial CT scan obtained with IV and oral contrast material at level of upper pelvis shows cluster of lymph nodes (arrows) in right lower quadrant mesentery. Mild thickening of terminal ileum (not shown) was present. Patient was treated with antibiotics but pain increased.

 


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  		Fig. 6B. —Mesenteric adenitis in 25-year-old man with right lower quadrant pain. Spot radiograph of terminal ileum from small-bowel series performed 2 days after CT shows nodularity to mucosa of the terminal ileum (arrow). Differential diagnosis includes infectious and other causes of terminal ileitis such as Crohn's disease. Colonoscopy and biopsy of terminal ileum revealed severe nonspecific enteritis without granulomas or infectious agent. Antibiotics were discontinued, and patient slowly improved.

 

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