E4591. Mesenteric Disease: Differential Diagnosis and Imaging Approach
  1. Mohamed Badawy; Wayne State University
  2. Arif Musa; Wayne State University
  3. Alhassan Alhasson; Wayne State University
  4. Elmira Taghi Zadeh; Wayne State University
  5. Mohamed Elsingery; Wayne State University
  6. Mahmoud Abbas; Wayne State University
  7. Gulcin Altinok; Wayne State University
The misty mesentery was first defined in 1996 as increased attenuation of mesenteric fat. It is frequently encountered in imaging and is used to identify a broad range of differential diagnoses. An imaging approach is needed to address the diagnostic dilemma of these pathological entities infiltrating the mesentery such as inflammation, edema, malignancy, or fibrous tissue.

Educational Goals / Teaching Points
Review the mesenteric anatomy. Discuss the different etiologies of mesenteric diseases. Highlight the unique imaging features of each entity that may narrow the differential diagnosis and its imaging pitfalls.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Peritoneal and mesenteric anatomy (small bowel, transverse mesocolon and sigmoid mesentery). Differential diagnosis of mesenteric disease: Sclerosing mesenteritis (Mesenteric panniculitis and retractile mesenteritis); Inflammation (Pancreatitis, Crohn's disease, Diverticulitis, COVID 19, peritonitis, autoimmune e.g., IgG4-related disease); Edema (Heart failure, Renal failure, Liver Cirrhosis, Budd Chiari, iatrogenic); Hemorrhage; and Neoplasms (Lymphoma, carcinoid, desmoid tumor, peritoneal carcinomatosis, omental cake, mesothelioma, pseudomyxoma peritonei). Imaging features of different entities with similarities and differences between etiologies. Practical approach to narrow the differential diagnosis.

Misty mesentery is a widely common finding in abdominal imaging however nonspecific. Radiologists should be aware of the key imaging features and the pertinent clinical history of each entity mesenteric disease to significantly narrow the differential diagnosis.