Teaching Case

The patient had complaints of intermittent mid-abdominal pain, lack of appetite, weight loss, high fever and sweating at nights for a few weeks. He had no history of prior abdominal surgery.

49-year-old-man was admitted to our hospital with complaints of intermittent abdominal pain, lack of appetite and weight loss. The physical examination revealed slightly tender and suspect mass in the mid-abdomen. Laboratory findings were normal except microcytic anemia. Then, upper gastrointestinal endoscopic examination and biopsy were performed. There were congestion and erosion in antrum. Villous atrophy, marked plasma cell infiltration and slightly leucocyte infiltration were detected in duodenum so that the findings were correlated with non-specific enteropathy. In addition, Computed Tomography (Siemens, Somatom Plus 4 helical CT, Erlangen, Germany) was performed with oral and IV contrast media. CT scan showed that the masslike lesion was arising from the mesentery which surrounded the superior mesenteric artery (SMA) accompanying with various sized lymph nodes (Figure 1A-B). The mesenteric fatty tissue was markedly dense due to inflammation and surrounded by a sheathlike stripe. The patient subsequently underwent surgery. Laparotomy revealed the mass in the small bowel mesentery with involvement of the SMA. The mass and mesenteric lymph nodes were resected. Histologic examination depicted that lipid- laden macrophages were seen in the resected mass and the lymph nodes composed of reactive, benign, hyperplastic in nature and had caseous necrosis. The diagnosis was tuberculous lymphadenitis. After anti-tuberculous treatment for 9 months, the control CT was performed. Abdominal lymph nodes were disappeared. Although there was an improvement in the mesenteric fat findings, increased density in the mesentery with a slightly hyperdense stripe could be seen (Figure 2).

The non-specific mesenteritis was probably related to a variety of conditions such as infection, trauma, ischemia, vasculitis, granulomatous disease, and malignencies (1,2). The CT findings of our case are quite similar to Daskalogiannaki et al’s (1). Their CT findings were as follows; a solitary well-defined mass composed of inhomogeneous fatty tissue with attenuation values higher than those of the retroperitoneal fat at the root of small bowel mesentery, engulfment of superior mesenteric vessels without vascular involvement, and no evidence of the adjacent small bowel loops even if displaced. Chopra et al (3) revealed that mesenteric, omental and retroperitoneal edema occurred commonly in patients with cirrhosis. Their CT findings of mesenteric edema were almost the same as ours. Sabate et al (4) mentioned that the presence of “pseudotumoral stripe” around the mesenteritis lesions on CT. They pointed out that this finding was important for the diagnosis. Since our case had present the same finding, we supported their hypothesis.