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Institut de Diagnòstic per la Imatge, Hospital Duran i Reynals, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
I was interested in the work of Sabaté et al. [1] in the March issue of the AJR, particularly because we recently found a patient with similar CT findings but a different histologic diagnosis.
The patient was a 66-year-old man who was referred to our hospital for evaluation of lower abdominal pain and diarrhea. Physical examination revealed slight abdominal tenderness and bilateral lymph nodes. Barium enema and upper and lower endoscopies had unremarkable findings. Abdominal CT performed in another institution disclosed extensive retroperitoneal and mesenteric lymphadenopathy (Fig. 2A). Biopsy of the inguinal lymph nodes showed findings consistent with mantle cell lymphoma and the patient was started on a course of chemotherapy. Follow-up CT 5 and 9 months later showed progressive shrinkage and eventually complete disappearance of the enlarged lymph nodes in the mesentery and retroperitoneum. The patient remained free of disease and clinically asymptomatic. Repeated CT 18 months later showed increased density and stranding of the fat in the root of the mesentery and no evidence of retroperitoneal or mesenteric lymph nodes. A low-density fat halo around mesenteric vessels (fat-ring sign) was clearly seen (Fig. 2B).
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Sabaté et al. are to be commended for the thorough radiopathologic correlation with different imaging techniques in sclerosing mesenteritis. We agree with the authors that preservation of a fatty halo around mesenteric vessels may be valuable in suggesting a diagnosis of sclerosing mesenteritis. However, from the viewpoint of imaging, these findings are relatively nonspecific and can be observed in a number of disorders.
Recently, Mindelzum et al. [2] showed that infiltration of the mesentery by a wide range of diseases may be characterized by mesenteric fat with an increased density that closely mimics sclerosing mesenteritis. This finding is not surprising because sclerosing mesenteritis is actually, as the authors correctly point out, a spectrum of inflammation and scarring in the mesentery and omentum. Histologically, this entity consists of tissue thickening with varying degrees of chronic inflammation, fat necrosis, and fibrosis [3]. The same histologic features may be present in non-Hodgkin's lymphoma after chemotherapy treatment has led to shrinkage of the size of the mesenteric lymph nodes. Although histologic studies are generally not performed in that setting, the presence of residual mesenteric abnormalities on an abdominal CT scan may represent only necrotic and fibrotic tissue.
In conclusion, although in a particular patient with a palpable mass and increased density of the root of the mesentery the fat ring sign may be suggestive of sclerosing mesenteritis, this finding is nonspecific. Knowledge of the clinical setting is critical because other entities may have overlapping CT features.
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  P. Yenarkarn, R. F. Thoeni, and D. Hanks Case 107: Lymphoma of the Mesentery Radiology, February 1, 2007; 242(2): 628 - 631. [Full Text] [PDF]
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 A. D. Levy, J. Rimola, A. K. Mehrotra, and L. H. Sobin From the Archives of the AFIP: Benign Fibrous Tumors and Tumorlike Lesions of the Mesentery: Radiologic-Pathologic Correlation RadioGraphics, January 1, 2006; 26(1): 245 - 264. [Abstract] [Full Text] [PDF]
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B. C. Lucey, J. W. Stuhlfaut, and J. A. Soto Mesenteric Lymph Nodes Seen at Imaging: Causes and Significance RadioGraphics, March 1, 2005; 25(2): 351 - 365. [Abstract] [Full Text] [PDF]
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