Mesenteric Adenitis

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.