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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

A. Transverse view of small intestinal mesenteric volvulus in the B-mode (arrows) in a 6-year-old girl. A – aorta, V – inferior vena cava. B. The same girl as in Fig. 14 A but in the duplex Doppler. The measuring gate is in the superior mesenteric artery which is the rotation axis; this caused mesenteric vein dilatation
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Figure 0014: A. Transverse view of small intestinal mesenteric volvulus in the B-mode (arrows) in a 6-year-old girl. A – aorta, V – inferior vena cava. B. The same girl as in Fig. 14 A but in the duplex Doppler. The measuring gate is in the superior mesenteric artery which is the rotation axis; this caused mesenteric vein dilatation

Mentions: complete nonrotation is the most common defect. The small intestine occupies the right side of the abdominal cavity, and the large bowel is located on the left side. This is reflected in the position of the superior mesenteric vessels. Their interposition in a transverse view of the root of the small intestinal mesentery is manifested by the fact that the superior mesenteric artery is located on the right side and the synonymous vein is on the left (Fig. 13). However, this sign is not characterized by a high specificity since incomplete rotation has been observed with the vein located above the artery or without mesenteric vein transposition. This has been explained either with a pathological compression of the mesenteric root by a mass or reverse visceral position(48). According to our observations, scoliosis can be another cause. Since, in this anomaly, the mesenteric root is narrow, it sometimes twists around the axis made by the superior mesenteric artery, which is clinically manifested by signs of high gastrointestinal obstruction and in ultrasound – by its pathognomonic sign, i.e. whirlpool sign (Fig. 14 A, B). Internal paraduodenal hernia is another complication of this anomaly;


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

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

A. Transverse view of small intestinal mesenteric volvulus in the B-mode (arrows) in a 6-year-old girl. A – aorta, V – inferior vena cava. B. The same girl as in Fig. 14 A but in the duplex Doppler. The measuring gate is in the superior mesenteric artery which is the rotation axis; this caused mesenteric vein dilatation
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0014: A. Transverse view of small intestinal mesenteric volvulus in the B-mode (arrows) in a 6-year-old girl. A – aorta, V – inferior vena cava. B. The same girl as in Fig. 14 A but in the duplex Doppler. The measuring gate is in the superior mesenteric artery which is the rotation axis; this caused mesenteric vein dilatation
Mentions: complete nonrotation is the most common defect. The small intestine occupies the right side of the abdominal cavity, and the large bowel is located on the left side. This is reflected in the position of the superior mesenteric vessels. Their interposition in a transverse view of the root of the small intestinal mesentery is manifested by the fact that the superior mesenteric artery is located on the right side and the synonymous vein is on the left (Fig. 13). However, this sign is not characterized by a high specificity since incomplete rotation has been observed with the vein located above the artery or without mesenteric vein transposition. This has been explained either with a pathological compression of the mesenteric root by a mass or reverse visceral position(48). According to our observations, scoliosis can be another cause. Since, in this anomaly, the mesenteric root is narrow, it sometimes twists around the axis made by the superior mesenteric artery, which is clinically manifested by signs of high gastrointestinal obstruction and in ultrasound – by its pathognomonic sign, i.e. whirlpool sign (Fig. 14 A, B). Internal paraduodenal hernia is another complication of this anomaly;

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