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Intra-abdominal fat. Part II: Non-cancerous lesions of the adipose tissue localized beyond organs.

Smereczyński A, Kołaczyk K, Bernatowicz E - J Ultrason (2016)

Bottom Line: The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way.This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland.

ABSTRACT
Adipose tissue does not belong to the most favorite structures to be visualized by ultrasound. It is not, however, free from various pathologies. The aim of this paper is to make abdominal cavity examiners more familiar with non-cancerous lesions found in intra-abdominal fat. The main focus is lesions that are rarely discussed in the literature. Visceral adiposity is one of important pathogenetic factors contributing to cardiovascular events, metabolic syndrome and even certain neoplasms. That is why this article exposes sonographic features that are the most characteristic of these lesions. The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way. Moreover, the article discusses more and more common mesenteritis, the lack of knowledge of which could pose difficulties in explaining the nature of symptoms reported by patients. Furthermore, this review presents lesions referred to in the literature as focal infarction of intra-abdominal fat. This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis. These lesions should be assessed with respect to the clinical context, and appropriate techniques of ultrasonography should be employed to allow careful determination of the size, shape, acoustic nature and location of lesions in relation to the integuments and large bowel, as well as their reaction to compression with an ultrasound transducer and behavior during deep inspiration. Moreover, each lesion must be obligatorily assessed in terms of blood flow. Doppler evaluation enables the differentiation between primary and secondary inflammation of intra-abdominal fat. The paper also draws attention to a frequent indirect sign of a pathological process, i.e. thickening and hyperechogenicity of fat, which sometimes indicates an ongoing pathology at a deeper site. This structure may completely conceal the primary lesion rendering it inaccessible for ultrasound. In such cases and in the event of other doubts, computed tomography should be the next diagnostic step.

No MeSH data available.


Related in: MedlinePlus

Two views show fatty root of the small intestinal mesentery with visible superior mesenteric vessels
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Figure 0002: Two views show fatty root of the small intestinal mesentery with visible superior mesenteric vessels

Mentions: Visceral adiposity. Overdeveloped visceral adipose tissue is one of the causes of severe lifestyle diseases, such as metabolic syndrome, cardiovascular diseases and neoplasms(1–4). Despite this, visceral adiposity is ignored in a considerable majority of US scans, which should be considered an error. Informing patients about these lesions should mainly entail pro-health lifestyle changes thus contributing to the reduction of the risk of the diseases mentioned above and their complications. There have been numerous studies that aimed to determine the relationship between the distribution of intra-abdominal fat and its negative influence on a range of organs. It turned out that mesenteric fat has the greatest hepatogenic and aterogenic action. It releases multiple lipotoxic substances, such as free fatty acids, adiponectin, tumor necrosis factor (TNF-alpha), plasminogen activator inhibitor type 1 and others, directly to the portal circulation(4–11). That is why the most valuable information is not delivered by a US examination of the thickness of subcutaneous and extraperitoneal fat but rather that of the mesentery. This has been demonstrated in various studies which helped determine that this parameter is an independent risk indicator of severe diseases(5, 7–11). Liu et al.(12), based on a multivariate logistic regression analysis, demonstrated that the value that differentiates normal and thickened mesenteric folds is 10 mm. The odds ratio of metabolic syndrome increased by 1.35-fold for every 1-mm increase in the thickness of this structure over the value of 10 mm. Ultrasound is the only imaging modality enabling accurate visualization of mesenteric folds. This is preferably performed by applying the transducer slightly to the left and downwards from the navel (Fig. 1). The mean value of three thickest folds should be calculated. The examination is simple and provides clinically significant information since cardiovascular diseases, metabolic syndrome and neoplasms are threats for the contemporary population. If mesenteric folds cannot be visualized, one should measure the thickness of the mesenteric root located above the navel (according to our initial conclusions, the value exceeding 25 mm is of a similar relevance as fold thickness) (Fig. 2). Also, it must be emphasized that excessively developed visceral fat is not always associated with obesity. Normal body mass index (BMI) is noted in some patients(13), which additionally increases the relevance of mesentery evaluation in ultrasound imaging, and not only based on anthropometric parameters.


Intra-abdominal fat. Part II: Non-cancerous lesions of the adipose tissue localized beyond organs.

Smereczyński A, Kołaczyk K, Bernatowicz E - J Ultrason (2016)

Two views show fatty root of the small intestinal mesentery with visible superior mesenteric vessels
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834369&req=5

Figure 0002: Two views show fatty root of the small intestinal mesentery with visible superior mesenteric vessels
Mentions: Visceral adiposity. Overdeveloped visceral adipose tissue is one of the causes of severe lifestyle diseases, such as metabolic syndrome, cardiovascular diseases and neoplasms(1–4). Despite this, visceral adiposity is ignored in a considerable majority of US scans, which should be considered an error. Informing patients about these lesions should mainly entail pro-health lifestyle changes thus contributing to the reduction of the risk of the diseases mentioned above and their complications. There have been numerous studies that aimed to determine the relationship between the distribution of intra-abdominal fat and its negative influence on a range of organs. It turned out that mesenteric fat has the greatest hepatogenic and aterogenic action. It releases multiple lipotoxic substances, such as free fatty acids, adiponectin, tumor necrosis factor (TNF-alpha), plasminogen activator inhibitor type 1 and others, directly to the portal circulation(4–11). That is why the most valuable information is not delivered by a US examination of the thickness of subcutaneous and extraperitoneal fat but rather that of the mesentery. This has been demonstrated in various studies which helped determine that this parameter is an independent risk indicator of severe diseases(5, 7–11). Liu et al.(12), based on a multivariate logistic regression analysis, demonstrated that the value that differentiates normal and thickened mesenteric folds is 10 mm. The odds ratio of metabolic syndrome increased by 1.35-fold for every 1-mm increase in the thickness of this structure over the value of 10 mm. Ultrasound is the only imaging modality enabling accurate visualization of mesenteric folds. This is preferably performed by applying the transducer slightly to the left and downwards from the navel (Fig. 1). The mean value of three thickest folds should be calculated. The examination is simple and provides clinically significant information since cardiovascular diseases, metabolic syndrome and neoplasms are threats for the contemporary population. If mesenteric folds cannot be visualized, one should measure the thickness of the mesenteric root located above the navel (according to our initial conclusions, the value exceeding 25 mm is of a similar relevance as fold thickness) (Fig. 2). Also, it must be emphasized that excessively developed visceral fat is not always associated with obesity. Normal body mass index (BMI) is noted in some patients(13), which additionally increases the relevance of mesentery evaluation in ultrasound imaging, and not only based on anthropometric parameters.

Bottom Line: The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way.This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland.

ABSTRACT
Adipose tissue does not belong to the most favorite structures to be visualized by ultrasound. It is not, however, free from various pathologies. The aim of this paper is to make abdominal cavity examiners more familiar with non-cancerous lesions found in intra-abdominal fat. The main focus is lesions that are rarely discussed in the literature. Visceral adiposity is one of important pathogenetic factors contributing to cardiovascular events, metabolic syndrome and even certain neoplasms. That is why this article exposes sonographic features that are the most characteristic of these lesions. The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way. Moreover, the article discusses more and more common mesenteritis, the lack of knowledge of which could pose difficulties in explaining the nature of symptoms reported by patients. Furthermore, this review presents lesions referred to in the literature as focal infarction of intra-abdominal fat. This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis. These lesions should be assessed with respect to the clinical context, and appropriate techniques of ultrasonography should be employed to allow careful determination of the size, shape, acoustic nature and location of lesions in relation to the integuments and large bowel, as well as their reaction to compression with an ultrasound transducer and behavior during deep inspiration. Moreover, each lesion must be obligatorily assessed in terms of blood flow. Doppler evaluation enables the differentiation between primary and secondary inflammation of intra-abdominal fat. The paper also draws attention to a frequent indirect sign of a pathological process, i.e. thickening and hyperechogenicity of fat, which sometimes indicates an ongoing pathology at a deeper site. This structure may completely conceal the primary lesion rendering it inaccessible for ultrasound. In such cases and in the event of other doubts, computed tomography should be the next diagnostic step.

No MeSH data available.


Related in: MedlinePlus