The Prevalence of Incidentally Detected Idiopathic Misty Mesentery on Multidetector Computed Tomography: Can Obesity Be the Triggering Cause?

PURPOSE: Misty mesentery appearance is commonly reported in daily practice, usually as a secondary finding of various pathological entities, but sometimes it is encountered as an isolated finding that cannot be attributed to any other disease entity. We aimed to assess the prevalence of cases with incidentally detected idiopathic misty mesentery on computed tomography (CT) and to summarize the pathologies leading to this appearance. METHODS: Medical records and initial and follow-up CT features of patients with misty mesentery appearance between January 2011 and January 2013 were analysed. The study included cases with no known cause of misty mesentery according to associated CT findings, clinical history, or biochemical manifestations, and excluded patients with diseases known to cause misty mesentery, lymph nodes greater than a short-axis diameter of 5 mm, discrete mesenteric masses, or bowel wall thickening. RESULTS: There were a total of 561 patients in whom misty mesentery appearance was depicted on abdominopelvic CT scans. A total of 80 cases were found to have isolated incidental idiopathic misty mesentery, giving a prevalence of 7%. The common indication for CT examination was abdominal pain. There was a slight female predominance (51.3%). 67.5% of all patients were classified as obese and 17.5% as overweight. CONCLUSIONS: The results of the present study show that idiopathic incidental misty mesentery appearance has a significant prevalence. Also, the high body mass index of these patients and the growing evidence of obesity-induced inflammatory changes in adipose tissue are suggestive of an association between obesity and misty mesentery appearance on CT.

Jejunal Diverticulosis Presented with Acute Abdomen and Diverticulitis Complication: A Case Report.

BACKGROUND: Jejunal diverticulosis is a rare, usually asymptomatic disease. Its incidence increases with age. If symptomatic, diverticulosis may cause life-threatening acute complications such as diverticulitis, perforation, intestinal hemorrhage and obstruction. In this report, we aimed to present a 67-year-old male patient with jejunal diverticulitis accompanying with abdominal pain and vomiting. CASE REPORT: A 67-year-old male patient complaining of epigastric pain for a week and nausea and fever for a day presented to our emergency department. Ultrasonographic examination in our clinic revealed diverticulum-like images with thickened walls adjacent to the small intestine loops, and increase in the echogenicity of the surrounding mesenteric fat tissue. Contrast-enhanced abdominal computed tomography showed multiple diverticula, thickened walls with showing contrast enhancement and adjacent jejunum in the left middle quadrant, increased density of the surrounding mesenteric fat tissue, and mesenteric lymph nodes. The patient was hospitalized by general surgery department with the diagnosis of jejunal diverticulitis. Conservative intravenous fluid administration and antibiotic therapy were initiated. Clinical symptoms regressed and the patient was discharged from hospital after 2 weeks. CONCLUSIONS: In cases of diverticulitis it should be kept in mind that in patients with advanced age and pain in the left quadrant of the abdomen, diverticular disease causing mortality and morbidity does not always originate from the colon but might also originate from the jejunum.

Bisphosphonate-induced bilateral acute renal cortical necrosis.

Renal cortical necrosis (RCN), a rare cause of renal failure in which there is death of the renal cortex but sparing of the medulla, is a catastrophic entity with high mortality. Its incidence and severity are higher in developing countries, mostly due to pregnancy-related complications. This paper presents the case of a 65-year-old woman who had bilateral renal cortical necrosis caused by bisphosphonate medication that was diagnosed by CT scan during the acute initial phase of the disease.

Alterations in pituitary gland volume in polycystic ovary syndrome: a structural magnetic resonance imaging study.

The purpose of this prospectively designed cross-sectional observational study was to evaluate the effect of polycystic ovary syndrome (PCOS) on pituitary gland volume (PGV) under the hypothesis that endocrinologic changes may lead to morphologic changes of the pituitary gland. Twenty-six PCOS patients and 31 control subjects underwent magnetic resonance imaging (MRI) of the pituitary. Informed consent was obtained from all subjects. PGV was significantly larger in PCOS patients than in control subjects. Luteinizing hormone/follicle-stimulating hormone ratio was the only predictor of PGV. The association between pituitary gland enlargement and PCOS should be kept in mind when pituitary hypertrophy is detected on MRI.

The sensitivity of MR colonography using dark lumen technique for detection of colonic lesions.

BACKGROUND/AIMS: To assess the detectability of the lesions with magnetic resonance (MR) colonography using dark lumen technique that had been detected on conventional colonoscopy. MATERIALS AND METHODS: A total of 38 patients who were suspected to have a colorectal mass between April 2008 and June 2010 were included in this prospective study. Warm tap water was administered via a rectal tube to the patients in prone position. Then, axial T2 true- fast imaging with steady-state precession (FISP), axial T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE), diffusion-weighted images, and T1 vibe fat suppression coronal sequences were obtained. T1 vibe fat suppression sequences on axial coronal planes were repeated after gadolinium contrast medium intravenous injection. MR images were analyzed by two radiologists concurrently. Assessments were done by comparing with conventional colonoscopy and histopathologic findings. RESULTS: Thirteen out of 20 lesions that had been detected on conventional colonoscopy were correctly obtained by MR colonography. None of the three lesions 5 mm or below was seen on MR colonography. Two out of 4 lesions measuring 6-9 mm were seen on MR colonography (50%). Eleven out of 13 lesions 10 mm and above were correctly detected on MR colonography (84.6%). Sensitivity was estimated as 65% when all lesions were evaluated together. CONCLUSION: MR colonography has a high sensitivity in the diagnosis of colonic pathologies without ionizing radiation. Future investigation will likely lead to wider acceptance of this method to detect colonic pathologies, including perhaps their use in colon cancer screening programs.