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Mesenteric Neoplasms: CT Appearances of Primary and Secondary Tumors and Differential Diagnosis¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, HAL B176D, Baltimore, MD 21287. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received April 17, 2002; revision requested July 16 and received August 22; accepted August 23. Address correspondence to S.S. (e-mail: ssheth@jhmi.edu).

Computed tomography (CT) remains the optimal imaging modality for diagnosing tumors in the mesentery. Although primary neoplasms arising from the mesenchymal tissues of the mesentery are rare, the small bowel mesentery is a major avenue for the dissemination of tumor within the peritoneal cavity. Tumors spread to the mesentery by four major routes: (a) direct extension, commonly seen with carcinoid tumor of the small intestine as well as intraabdominal cancers such as pancreatic and colon cancer; (b) lymphatic dissemination of lymphoma and some epithelial malignancies; (c) hematogenic spread resulting in embolic metastases to the small intestinal wall, usually seen in melanoma and breast cancer; and (d) seeding through the peritoneum from ovarian and gastrointestinal malignancies as well as some lymphomas. Although percutaneous imaging-guided or surgical biopsy is often necessary to guide management, analysis of CT features along with the clinical history may be useful in differentiating mesenteric tumors from infectious, inflammatory, or vascular processes affecting the mesentery. The article presents the characteristic appearances of primary and secondary mesenteric neoplasms at CT and offers a rational approach to the differential diagnosis of mesenteric masses depicted at CT.

© RSNA, 2003

Index Terms: Mesentery, CT, 792.12112 • Mesentery, neoplasms, 792.30

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