KEY POINTS 1. The term “misty mesentery” was coined by Mindelzun et al. in 1996 to describe a regional increase in mesenteric fat density that is seen frequently at abdominopelvic CT. 2. Mesenteric panniculitis (MP) is one of the broad range of disorders that may result in the imaging finding of a misty mesentery on CT. 3. MP cannot be diagnosed on CT without the exclusion of many other possible causes of a misty mesentery including disorders that result in mesenteric edema, lymphedema, hemorrhage, and infiltration with inflammatory or neoplastic cells. 4. Retractile mesenteritis results in irregular fibrotic mesenteric masses that simulate a number of neoplastic conditions of the mesentery and peritoneum such as carcinoid tumors, desmoid tumors, and perito-neal carcinomatosis.

https://www.ajronline.org/doi/pdf/10.2214/AJR.12.8493

The "misty mesentery": mesenteric panniculitis and its mimics.

Weber-Christian disease (WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation, being the subcutaneous adipose tissue the most frequent one, followed by liver, spleen, bone marrow and mesenteric adipose tissue. Systemic corticosteroids are first line treatment, but other options should be considered if systemic symptoms are observed or in case of refractory clinical situation. We report herein a case with WCD showing orbital, mesenteric and ileocolonic involvement, which required surgical treatment and also developed postoperative recurrence. Symptoms were resolved by administration of thalidomide and, afterwards, infliximab. To our knowledge, this is the first report of Weber-Christian disease with luminal ileocolonic involvement, treated with infliximab.

Weber-Christian disease with ileocolonic involvement successfully treated with infliximab.

Mesenteric panniculitis is a chronic inflammatory process involving the adipose tissue of the mesentery. The etiology is unknown, and it is rare in children. We report a 5 year old girl who presented with abdominal symptoms and was misdiagnosed as appendicular mass. The correct diagnosis was established after surgical resection.

/pdf/mesenteric-panniculitis-in-a-child-misdiagnosed-as-4sxgfgo0yr.pdf

Mesenteric panniculitis in a child misdiagnosed as appendicular mass: a case report and review of literature

Pfeifer-Weber-Christian disease (PWCD) is a rare idiopathic disease characterized by lobular panniculitis of adipose tissue with systemic symptoms and multiple organ involvement. Even though the systemic involvement is rare, it is life-threatening and represent a treatment challenge for the clinicians. We report a case of PWCD characterized by hepatic, hematologic, and renal involvement, with good response to mofetil mycophenolate and prednisone treatment. A 47-year-old female presented several months' history of painful subcutaneous nodules, fever and lymphadenopathy with recent appearing of microcytic hypochromic anemia, leucopenia with neutropenia, and increase in transaminase. Skin biopsy showed lobular panniculitis with lymph-histiocytic and neutrophilic infiltrates with necrosis of adipocytes. A combination therapy of corticosteroid with mofetil mycophenolate was effective. Moreover, we discuss the clinical manifestation and the therapeutic choices in PWCD, from classical immunosuppressive drugs to new biotechnological agents, and we provide a comprehensive review of the available literature.

https://journals.sagepub.com/doi/pdf/10.1177/1179547620917958

Pfeifer-Weber-Christian Disease: A Case Report and Review of Literature on Visceral Involvements and Treatment Choices:

Acari C, Unsal E, Hakguder G, Soylu A, Ozer E. Pediatric mesenteric panniculitis: three cases and a review of the literature. Turk J Pediatr 2019; 61: 798-803. Mesenteric panniculitis is an inflammatory and fibrotic process in the mesenteric adipose tissue with unknown etiology. It is rarely seen in general, particularly in children. Etiology is unknown, and pathophysiology is not clear. Factors that trigger the disease are malignancy, tuberculosis, trauma, medications and past surgical interventions. There is no pediatric case series in the literature except single case reports. This paper consists of 3 cases: The first case is a 5-month-old girl, the youngest patient in the literature, who was referred to a pediatric surgeon with vomiting and abdominal distention. She had diffused intraabdominal fluid and mesenteric panniculitis documented by perioperative biopsy. The second case had acute abdominal pain with perforated appendicitis, who eventually had mesenteric panniculitis in the evaluation of the pathological specimen. The last case had a diagnosis of polyarticular juvenile idiopathic arthritis (JIA), successfully treated with etanercept, and has been in remission for 2 years. Interestingly, in one of her routine visits, she had pallor, anemia and renal failure. Bilateral hydronephrosis was detected. Magnetic resonance imaging (MRI) of the abdomen revealed retroperitoneal fibrosis, and mesenteric panniculitis was the histopathological diagnosis.

/pdf/pediatric-mesenteric-panniculitis-three-cases-and-a-review-3kw278jl1m.pdf

Pediatric mesenteric panniculitis: three cases and a review of the literature.

Sclerosing mesenteritis in a child with celiac disease.

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Sclerosing mesenteritis in a child with celiac disease.