Mesenteric Adenitis and Enteritis

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 Mesenteric adenopathy is often much more evident on coronal-reformatted CT

• Ileal ± cecal wall thickening, sometimes with regional ileus

image Mucosal hyperenhancement, submucosal edema
• Normal-appearing appendix

TOP DIFFERENTIAL DIAGNOSES

• Appendicitis
• Crohn disease

image Early Crohn disease may be impossible to distinguish
image Time course and likelihood of recurrence are different
• Cecal or appendiceal carcinoma

image Affects older adults, not children

PATHOLOGY

• Reactive lymph node enlargement secondary to enteric pathogens
• Viral (most common)
• Bacterial (especially Yersinia and Campylobacter species)

CLINICAL ISSUES

• Commonly seen in children and young adults < 25 years old

image 8-12% of young patients with acute RLQ pain have mesenteric adenitis
• Pain, fever, nausea, vomiting

image Leukocytosis
• Self-limited, usually resolves without treatment
image
(Left) Axial CT in a 25-year-old woman presenting with fever and RLQ tenderness shows wall thickening and mucosal hyperenhancement of the terminal ileum and cecum image.

image
(Right) Another CT section in the same patient shows a normal appendix image, excluding appendicitis as the diagnosis.
image
(Left) Coronal-reformatted image in the same patient shows a cluster of mildly enlarged ileocolic mesenteric nodes image, along with the thick-walled, inflamed terminal ileum image.

image
(Right) Another coronal CECT section shows enlarged nodes and engorged vessels in the ileocolic mesentery image, along with the thick-walled terminal ileum. These are classic imaging and CT features of mesenteric adenitis and enteritis, and the patient made an uneventful recovery without specific therapy.

TERMINOLOGY

Definitions

• Benign inflammation of lymph nodes in ileal mesentery, often with terminal ileitis

IMAGING

General Features

• Best diagnostic clue

image Cluster of slightly prominent (≥ 5 mm) mesenteric lymph nodes in right lower quadrant (RLQ)

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