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Community Acquired Pneumonia — UKMLA MCQ

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HardInfectious DiseasesCommunity Acquired PneumoniaUKMLAMRCP Part 1MRCEM SBAPARAPSA

A 63-year-old with vague abdominal pain has a CT showing increased attenuation at the root of the small-bowel mesentery, small soft-tissue nodules and a thin surrounding pseudocapsule. Fat immediately around the mesenteric vessels is relatively preserved. Which diagnosis best fits this pattern?

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Correct answer: D — Sclerosing mesenteritis

The best answer is “Sclerosing mesenteritis”. Sclerosing mesenteritis encompasses mesenteric panniculitis, fat necrosis and retractile fibrosis. Its characteristic CT findings include a misty mesentery or mass-like increased attenuation, small nodes, a pseudocapsule and the fat-ring sign—preservation of fat around mesenteric vessels and nodes. Carcinoid desmoplasia more often radiates from a focal enhancing mass and may narrow vessels; lymphoma can produce bulky nodal masses but does not typically preserve a fatty halo in this configuration. Portal oedema and carcinomatosis also lack this paired fat-ring and pseudocapsule pattern.

Reference: Sclerosing mesenteritis comprehensive clinical review: https://pmc.ncbi.nlm.nih.gov/articles/PMC6174187/