Mesenteric lymphadenitis; a common diagnostic mimic to acute appendicitis. With radiology it is no more a diagnosis of exclusion, laparoscopy or surgery
Mesenteric lymphadenitis (ML) is an inflammatory response to viral infections, bacterial infections, inflammatory bowel disease, or lymphoma in the ileocecal regions. It is a common diagnostic mimic to acute appendicitis. It is a self-limited inflammatory process that affects mesenteric lymph nodes in the right lower quadrant (RLQ). We present a 15 year-old-girl with low grade fever and RLQ pain. Initial physical examination and laboratory investigations suggested acute appendicitis. However, diagnosis of ML was established by the finding abnormal lymph nodes that are usually: (a) clusters of > 3 tender ones anterior to right psoas muscle or in the small bowel mesentery, (b) > 5 mm in diameter of short axis, and (b) rounded in shape. In addition; the ileal or ileocecal wall is thickened (> 3 mm) over at least 5 cm of the bowel and the appendicular wall is normal and its lumen is patent. In conclusion; this case reports indicates tha with radiology; ML can be differentiated from acute appendicitis and limits the role of invasive laparoscopy or surgery in exclusion of the latter.
Keywords: appendicitis, CT, mesenteric lymphadenitis, radiology, US.
2- Vignault F, Filiatrault D, Brandt ML, Garel L, Grignon A, Ouimet A. Acute appendicitis in children: evaluation with US. Radiol. 1990; 176:501-504.
3- Helbling, R., Conficconi, E., Wyttenbach, M., Benetti, C., Simonetti, G. D., Bianchetti, M. G., Hamitaga, F., Lava, S. A., Fossali, E. F., & Milani, G. P. (2017). Acute Nonspecific Mesenteric Lymphadenitis: More Than "No Need for Surgery". BioMed res int. 2017, 9784565.
4- Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric lymph nodes: detection and significance on MDCT. AJR Am J Roentgenol. 2005; 184:41-44.
5- Sahai S. Lymphadenopathy. Pediatr Rev. 2013; 34: 216-227.
6- Carr JA. Acute fulminant necrotizing mesenteric lymphadenitis causing bowel ischemia. J Surg Case Rep. 2019; 2019 (11):rjz304. doi: 10.1093/jscr/rjz304.
7- Birkhold M, Langenburg S. Is mesenteric adenitis a benign condition? Ischemic colitis secondary to mesenteric adenitis in a 12 year old. J Pediatr Surg Case Rep. 2016; 15:19-21.
8- Zinczuk J, Wojskowicz P, Kisluk J, Fil D, Kemona A, Dadan J. Mesenteric lymphadenitis caused by Yersinia enterocolitica. Prz Gastroenterol. 2015; 10:118-21.
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