CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease

Sclerosing mesenteritis is a complex inflammatory disorder of the mesentery. Although sclerosing mesenteritis is often associated with other idiopathic inflammatory disorders such as retroperitoneal fibrosis, sclerosing cholangitis, Riedel thyroiditis, and orbital pseudotumor, its exact cause is unknown. The computed tomographic (CT) appearance of sclerosing mesenteritis will vary depending on the predominant tissue component (fat, inflammation, or fibrosis). CT plays an important role in suggesting the diagnosis in the proper clinical setting and can be useful in distinguishing sclerosing mesenteritis from other mesenteric diseases with similar CT features such as carcinomatosis, carcinoid tumor, lymphoma, desmoid tumor, and mesenteric edema. Nevertheless, surgical biopsy and pathologic analysis are usually necessary to make the diagnosis. Treatment may consist of therapy with steroids, colchicine, immunosuppressive agents, or orally administered progesterone. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited by vascular involvement. CT with three-dimensional volume rendering is optimal for accurate, noninvasive follow-up of sclerosing mesenteritis and of any potential complications.