Imaging
Mesenteric Adenitis
- Preliminary Diagnosis: Mesenteric Adenitis
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric adenitis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric adenitis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Mesenteric Adenitis
I. What imaging technique is first-line for this diagnosis
Ultrasound with graded compression
It should be noted that mesenteric adenitis is a diagnosis of exclusion and diagnostic imaging should be utilized when more sinister diagnoses are suspected (eg, appendicitis, intussusception).
II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric adenitis.
Advantages
Avoids the high radiation exposure of a CT scan
Relatively quick imaging procedure
Able to assess for a dilated appendix, free fluid in the abdomen, intussusception, ileal or ileocolic wall thickening, abscess and extent of lymphadenopathy
Disadvantages
Quality of the study is operator dependent.
Patient’s scanning characteristics including large body habitus and bowel gas may limit evaluation.
Evaluation of inflammatory and infectious bowel disease is limited.
III. What are the contraindications for the first-line imaging technique?
No significant contraindications
IV. What alternative imaging techniques are available?
CT of the abdomen and pelvis with intravenous and oral (PO) contrast
Acute abdominal series x-rays
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric adenitis.
CT of the abdomen and pelvis with intravenous and oral (PO) contrast
Advantages
Use in patients with equivocal ultrasound results or patients in whom alternative diagnoses are being considered (eg, colitis, peritonitis, inflammatory bowel disease, renal stones, pyelonephritis).
Disadvantages
Exposure to ionizing radiation
Acute abdominal series x-rays
Advantages
Can provide quick information regarding bowel dilation, obstruction and possible free air.
Disadvantages
Findings are often nonspecific.
VI. What are the contraindications for the alternative imaging techniques?
CT of the abdomen and pelvis with intravenous and oral (PO) contrast
Relative contraindication in patients with allergic reactions to contrast. Anaphylaxis to prior contrast administration is an absolute contraindication to intravenous contrast.
Relative contraindication in pregnant women
Relative contraindication in patients with renal failure
Acute abdominal series x-rays
No contraindications to plain radiographs. Consent may be required for pregnant patients at some institutions.
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