eMedicine Specialties > Gastroenterology > Intestine

Mesenteric Lymphadenitis: Differential Diagnoses & Workup

Author: Jennifer Lynn Bonheur, MD, Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Coauthor(s): Mukul Arya, MD, Associate Professor of Internal Medicine, Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center/Weill Medical College; Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama; Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center
Contributor Information and Disclosures

Updated: Aug 5, 2009

Differential Diagnoses

Appendicitis
Pyelonephritis, Acute
Benign Neoplasm of the Small Intestine
Salpingitis
Cholecystitis
Urinary Tract Infection, Females
Chronic Mesenteric Ischemia
Urinary Tract Infection, Males
Ectopic Pregnancy
Inflammatory Bowel Disease

Other Problems to Be Considered

Meckel diverticulitis
Intestinal duplication
Regional enteritis
Intussusception
Intestinal lymphoma
Other causes of acute abdomen (eg, porphyria, sickle cell vasoocclusive crises, cecal tumor, Familial Mediterranean Fever)

Workup

Laboratory Studies

  • CBC count: Leucocytosis with WBCs exceeding 10,000/µL occurs in at least 50% of cases.
  • Chemistries: - Findings are generally within reference ranges except in patients with severe nausea and vomiting who may present with metabolic alkalosis and azotemia.
  • Serology can be supportive in diagnosis of etiologic agents such as Y enterocolitica. Serological tests tend to be delayed, and several antigens may have to be tested.
  • Urinalysis may be useful to perform when the diagnosis is unclear and to exclude urinary tract infection.
  • In patients who present with diarrheal symptoms, stool cultures should be performed.
  • Blood culture: This is performed prior to prescribing antibiotics and in patients who have features of septicemia. Isolation of the organism from blood, lymph nodes, or other body fluids will help define appropriate therapy and guide further evaluation.

Imaging Studies

  • Contrast computed tomography (CT) demonstrates enlarged mesenteric lymph nodes, with or without associated ileal or ileocecal wall thickening, and a normal appearing appendix. In mesenteric adenitis, lymph nodes tend to be larger, greater in number, and more widely distributed than in appendicitis. Rao et al specified the criterion of 3 or more nodes with a short-axis diameter of at least 5 clustered in the right lower quadrant. CT scanning is also important to exclude other differential diagnoses, especially acute appendicitis.
  • Abdominal ultrasound scanning with Doppler scanning is a useful adjunct for excluding other differential diagnoses. For instance, ultrasonic demonstration of mural thickening of the terminal ileum plus mesenteric thickening is indicative of regional enteritis. Focal abdominal tenderness in response to transducer pressure is common. Ultrasound is often the preferred initial diagnostic procedure, especially in children with uncomplicated abdominal pain.

Procedures

  • Lymph node specimen: In patients subjected to laparotomy, lymph nodes may show evidence of inflammation or suppuration, and culture may yield causative organism.

More on Mesenteric Lymphadenitis

Overview: Mesenteric Lymphadenitis
Differential Diagnoses & Workup: Mesenteric Lymphadenitis
Treatment & Medication: Mesenteric Lymphadenitis
Follow-up: Mesenteric Lymphadenitis
References
[ CLOSE WINDOW ]

References

  1. Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ. Mar 9 2009;338:b716. [Medline]. [Full Text].

  2. Arrese M, Lopez F, Rossi R. Extrahepatic cholestasis attributable to tuberculous adenitis. Am J Gastroenterol. May 1997;92(5):912-3. [Medline].

  3. Asch MJ, Amoury RA, Touloukian RJ. Suppurative mesenteric lymphadenitis. A report of two cases and review of the literature. Am J Surg. Apr 1968;115(4):570-3. [Medline].

  4. Blattner RJ. Acute mesenteric lymphadenitis. J Pediatr. Mar 1969;DA - 19690327(3):479-81. [Medline].

  5. Campbell GL, Dennis TD. Plague and Other yersinia infections. In: Fauci AS et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;1998:975-983.

  6. Currie B. Yersinia enterocolitica. Pediatr Rev. Jul 1998;19(7):250; discussion 251. [Medline].

  7. Daly JM, Adams JT, et al. Abdominal wall, Omentum, Messentery and Retroperitoneum. In: Schwarttz ST et al, eds. Principles of Surgery. 7th ed. New York, NY: McGraw-Hill Health Professions Div;1999:1574-1575.

  8. Faller DV. Diseases of Lymph nodes and Spleen. In: Bennet JC et al, eds. Cecil Textbook of Medicine. WB Saunders;1996:1968-970.

  9. Kelly CS, Kelly RE Jr. Lymphadenopathy in children. Pediatr Clin North Am. Aug 1998;45(4):875-88. [Medline].

  10. Morris Jr JG. Yersinia infections. In: Bennet JC et al, eds. Cecil textbook of Medicine. WB Saunders;1996:1661.

  11. Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology. 1997;202:145-149.

  12. Schrock TR. Appendicitis. Gastrointestinal and Liver Disease, 6th Edition. 1998;1782.

  13. Sivit CJ. Imaging children with acute right lower quadrant pain. Pediatr Clin North Am. Jun 1997;44(3):575-89. [Medline].

  14. Zganjer M, Roic G, Cizmic A. Infectious ileocecitis--appendicitis mimicking syndrome. Bratisl Lek Listy. 2005;106(6-7):201-2.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

mesenteric lymphadenitis, mesenteric adenitis, mesenteric lymph nodes, intestinal lymphatics, Yersinia enterocolitica infection, peripheral lymphadenopathy, infectious Epstein-Barr virus, EBV, acute human immunodeficiency virus, HIV, catscratch disease, CSD, acute appendicitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jennifer Lynn Bonheur, MD, Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Academy of Sciences, New York Society for Gastrointestinal Endoscopy, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Mukul Arya, MD, Associate Professor of Internal Medicine, Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center/Weill Medical College
Mukul Arya, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Oluyinka S Adediji, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center
Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Vivek V Gumaste, MD, Associate Professor of Medicine, Mt Sinai School of Medicine; Adjunct Clinical Assistant, Mt Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center
Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas M Heuman, MD, FACP, FACG, AGAF, Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.