eMedicine Specialties > Radiology > Pediatrics

Mesenteric Adenitis: Follow-up

Author: Brian Burke, MD, Assistant Professor, Department of Radiology, University of New York School of Medicine; Consulting Radiologist, Department of Radiology, North Shore University Hospital
Coauthor(s): Micha Ziprkowski, MD, Associate Chief, Pediatric Radiology, Associate Professor of Clinical Radiology, Department of Radiology, North Shore University Hospital
Contributor Information and Disclosures

Updated: Aug 25, 2009

Intervention

Mesenteric adenitis is usually a self-limited disease, and management is conservative. Radiologic intervention is generally not indicated. Rotavirus and other viral vectors are the presumed cause in most cases. Although cultures are seldom obtained, most cases resolve without antibiotic treatment. There is a single case report, in the Japanese literature, of a patient with mesenteric adenitis and persistent abdominal pain whose symptoms responded to treatment with systemic corticosteroids; this patient also had erythema nodosum, suggesting an autoimmune process.23

Medicolegal Pitfalls

  • Medicolegal pitfalls are related to the possibility of misinterpreting the imaging findings in acute appendicitis as indicating mesenteric adenitis when reactive adenopathy is demonstrated but the appendix itself is not adequately seen. Fortunately, this is an uncommon scenario.
  • Although a normal appendix may be visualized in only 20-50% of patients, an inflamed appendix is more readily apparent, especially in small children.

Special Concerns

  • In the context of recent concerns about the radiation dose associated with pediatric CT, tailoring the examination protocol to the patient is prudent to minimize exposure during studies for benign and self-limited conditions such mesenteric adenitis.
  • In this respect, sonography is favored as the initial diagnostic test.
 


More on Mesenteric Adenitis

Overview: Mesenteric Adenitis
Imaging: Mesenteric Adenitis
Follow-up: Mesenteric Adenitis
Multimedia: Mesenteric Adenitis
References
Further Reading
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References

  1. Sung T, Callahan MJ, Taylor GA. Clinical and imaging mimickers of acute appendicitis in the pediatric population. AJR Am J Roentgenol. Jan 2006;186(1):67-74. [Medline]. [Full Text].

  2. 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].

  3. Schulte B, Beyer D, Kaiser C, et al. Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Eur J Ultrasound. Dec 1998;8(3):177-82. [Medline].

  4. Borgia G, Ciampi R, Nappa S, et al. Tuberculous mesenteric lymphadenitis clinically presenting as abdominal mass: CT and sonographic findings. J Clin Ultrasound. Sep 1985;13(7):491-3. [Medline].

  5. Puylaert JB. Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression. Radiology. Dec 1986;161(3):691-5. [Medline].

  6. Puylaert JB, van der Zant FM. Mesenteric lymphadenitis or appendicitis?. AJR Am J Roentgenol. Aug 1995;165(2):490. [Medline].

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

  8. Zippi M, Colaiacomo MC, Marcheggiano A, et al. Mesenteric adenitis caused by Yersinia pseudotubercolosis in a patient subsequently diagnosed with Crohn's disease of the terminal ileum. World J Gastroenterol. Jun 28 2006;12(24):3933-5. [Medline].

  9. Black RE, Slome S. Yersinia enterocolitica. Infect Dis Clin North Am. Sep 1988;2(3):625-41. [Medline].

  10. Hervas JA, Alberti P, Bregante JI, et al. Chronic intussusception associated with Yersinia enterocolitica mesenteric adenitis. J Pediatr Surg. Dec 1992;27(12):1591-2. [Medline].

  11. Quillin SP, Siegel MJ. Appendicitis in children: color Doppler sonography. Radiology. Sep 1992;184(3):745-7. [Medline].

  12. Blattner RJ. Acute mesenteric lymphadenitis. J Pediatr. Mar 1969;74(3):479-81. [Medline].

  13. Garcia-Corbeira P, Ramos JM, Aguado JM, Soriano F. Six cases in which mesenteric lymphadenitis due to non-typhi Salmonella caused an appendicitis-like syndrome. Clin Infect Dis. Jul 1995;21(1):231-2. [Medline].

  14. Hayden CK Jr. Ultrasonography of the acute pediatric abdomen. Radiol Clin North Am. Jul 1996;34(4):791-806. [Medline].

  15. American College of Radiology. ACR Appropriateness Criteria® right lower quadrant pain. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?doc_id=8593&nbr=004780. Accessed May 26, 2009.

  16. Simanovsky N, Hiller N. Importance of sonographic detection of enlarged abdominal lymph nodes in children. J Ultrasound Med. May 2007;26(5):581-4. [Medline].

  17. Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology. Jan 1997;202(1):145-9. [Medline]. [Full Text].

  18. Wiersma F, Toorenvliet BR, Ruige M, Holscher HC. Increased echogenicity of renal cortex: a transient feature in acutely ill children. AJR Am J Roentgenol. Jan 2008;190(1):240-3. [Medline]. [Full Text].

  19. Lee MW, Kim YJ, Jeon HJ, Park SW, Jung SI, Yi JG. Sonography of acute right lower quadrant pain: importance of increased intraabdominal fat echo. AJR Am J Roentgenol. Jan 2009;192(1):174-9. [Medline].

  20. Simonovsky V. Ultrasound in the differential diagnosis of appendicitis. Clin Radiol. Nov 1995;50(11):768-73. [Medline].

  21. Al-Kawas FH, Murgo A, Foshag L, Shiels W. Lymphadenopathy in celiac disease: not always a sign of lymphoma. Am J Gastroenterol. Mar 1988;83(3):301-3. [Medline].

  22. Achong DM, Oates E, Harris B. Mesenteric lymphadenitis depicted by indium 111-labeled white blood cell imaging. J Pediatr Surg. Dec 1993;28(12):1550-2. [Medline].

  23. Ikeda Y, Ikeda Y, Nakai T, Sano K, Ueda W, Aoki T, et al. A case of mesenteric lymphadenitis with long-acting symptom, showing marked response to corticosteroid. Nippon Shokakibyo Gakkai Zasshi. Sep 2007;104(9):1371-6. [Medline].

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Keywords

mesenteric adenitis, mesenteric lymphadenitis, acute ileitis, appendicitis, lymphoma

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Contributor Information and Disclosures

Author

Brian Burke, MD, Assistant Professor, Department of Radiology, University of New York School of Medicine; Consulting Radiologist, Department of Radiology, North Shore University Hospital
Brian Burke, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Micha Ziprkowski, MD, Associate Chief, Pediatric Radiology, Associate Professor of Clinical Radiology, Department of Radiology, North Shore University Hospital
Micha Ziprkowski, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Radiology, American Institute of Ultrasound in Medicine, Association of University Radiologists, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Medical Editor

Henrique M Lederman, MD, PhD, Consulting Staff, Department of Radiology, LeBonheur Children's Medical Center and St Jude Children's Research Hospital; Professor of Radiology and Pediatric Radiology, Chief, Division of Diagnostic Imaging in Pediatrics, Federal University of Sao Paulo, Brazil
Henrique M Lederman, MD, PhD is a member of the following medical societies: Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

David A Stringer, BSc, MBBS, FRCR, FRCPC, Professor, National University of Singapore; Head, Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
David A Stringer, BSc, MBBS, FRCR, FRCPC is a member of the following medical societies: British Columbia Medical Association, Canadian Association of Radiologists, European Society of Paediatric Radiology, Ontario Medical Association, Radiological Society of North America, Royal College of Physicians and Surgeons of Canada, Royal College of Radiologists, and Society for Pediatric Radiology
Disclosure: Sirius d'innovation None Board membership

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

 
 
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