Mesenteric panniculitis

[Christine Fenech]

Hi Steve, great to see some general content recently and amazing clips as always. I had a patient with a echogenic rounded mass overlying the pancreas recently that turned out to be mesenteric panniculitis with a ct. Not something I had thought of before so thought it worth mentioning here. I’ll try and find my pictures, no clips though 😬 thanks, Christine

[Stephen Bird]

Great work,

It is not an uncommon diagnosis in patients with acute abdonminal pain and normal visceral organs on ultrasound.

Well done noticing it.

Yes if you can find the images please post them in the forum.

The more cases people see, the easier it is to diagnose yourself.

And next time yeah, clip the S#*T out of it !!

🤣

See ya soon,

Steve

[Christine Fenech]

Here are images

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[Stephen Bird]

That is a great example,

The echogenic fat catches your eye,

The patient is point tender in that area,

You don’t know the exact diagnosis (panniculitis, epiploic apendagitis, diverticulitis etc)

BUT

You have made a diagnosis and a CT will give the rest of the detail.

It is so satisfying when you compare it to just doing a visceral organ exam and calling it normal.

Great work Octopus !

Steve

[Amanda Cessford]

I’ve imaged a few of these over the years & commented my worksheet- there was a good one recently where the patient had some pretty decent vascular disease in the SMA proximally (PSV a touch over 300 cm/sec). I’ve found some Radiologists reluctant to comment which is frustrating (especially when the patient is focally tender at the ROI). Hopefully these folks go on to get a CT- sadly in private practice, you don’t always get that follow-up/ feedback.

[Stephen Bird]

Hi Amanda,

Sounds like a nice case,

I would have thought a private practice would be more than ken to recommend a CT mesenteric angiogram to take a closer look. It is a great test and would have added a lot to your scan findings.

I am in Mareeba this weekend in far north Queensland teaching with the excellent group of sonos at Rural Medical Imaging. Yesterday we spoke about bowel ultrasound and around the fact that noticing a piece of echogenic mesenteric fat in the peritoneal cavity where the patient is tender is a great observation. It does not indicate a specific diagnosis, but it does cement the diagnosis that there is a bowel related issue producing the symptoms. The next logical step is to do a CT scan and this will determine if it is a case of diverticulitis, epiploic appendigitis, colitis, ileitis, appendicitis, panniculitis, bowel cancer etc.
The CT will work out which it is,
But the ultrasound puts the patient on the right diagnostic track.
It is the difference between the sonographer saying “all your organs look nice, I am not sure hat is causing your pain” and ” all your organs look nice but I can see where your pain is coming from as there is an area of inflamed fat sitting next to your bowel and with a CT scan we can work out what is causing your pain”
Such a big upgrade for the patient !

Well done Amanda,

You are a star.

Steve.

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