DESCRIPTIONA 62-year-old woman presented with a 3-day history of dull right-sided abdominal pain, radiating to her groin and exacerbated by movement. Her background included breast cancer, for which she had a wide local excision and hormonal treatment with tamoxifen and anastrozole, previous duodenal ulcers, vaginal hysterectomy and total thyroidectomy. Her abdomen was soft but tender; she was not guarding and no palpable masses were evident. Her C reactive protein (CRP) was elevated at 103 and CT scan demonstrated mesenteric panniculitis (figures 1 and 2). She was managed conservatively with analgesics and her symptoms and CRP settled.'Misty mesentery' is a region of increased mesenteric fat density, compared with retroperitoneal fat, and gives a hazy impression.1 In this CT the Hounsfield Units (HU) of the small bowel mesentery were −53 compared with −118 HU for retroperitoneal fat. Misty mesentery is a non-specific feature on abdominopelvic CT scans as it simply represents increased density. This can be due to oedema, inflammation, haemorrhage, lymphoedema and neoplasia and these causes need to be excluded. 1Mesenteric panniculitis represents the inflammatory stage in a spectrum of idiopathic primary mesenteric pathologies referred to as mesenteric sclerosis.2 Histologically mesenteric sclerosis ranges from lipodystrophy to necrosis and fibrosis. The prevalence of mesenteric panniculitis on abdominopelvic CT scans is 0.6%.3 Typical features include a left-sided distribution, a 'fat halo' sign, nodules and a pseudotumorous hyperattenuation stripe.3 It is associated with malignancy, surgery, infection, autoimmune conditions and trauma and can be managed medically with analgesia and steroids. 2Learning points ▸ 'Misty mesentery' is a non-specific finding on CT scans and a cause for this should be sought. ▸ CT changes consistent with mesenteric panniculitis include positive findings; a left-sided distribution, 'fat-halo' sign, pseudotumorous hyperattenuation stripe, nodules and the absence of features suggesting haemorrhage, neoplasia, lymphoedema or other organ involvement.Contributors BC identified and managed the case, read and revised the paper. HT identified the radiological diagnoses and provided expertise in the revision of the paper. PAN collected the information, looked at the literature and drafted and revised the paper. He was the guarantor.Competing interests None.Patient consent Obtained.
Purpose of the study To assess the outcome and recurrence rates of frozen shoulder treated by hydrodilatation in an independent hospital setting. Method Patients presenting to a shoulder clinic from August 2019 to July 2021 with a diagnosis of frozen shoulder were offered hydrodilatation. Data included primary or secondary frozen shoulder, length of symptoms, and diabetic status. An Oxford Shoulder Score was completed prior to hydrodilatation. Using ultrasound guidance, 40 mg Triamcinolone and local anaesthetic (10–25 mL depending on patient tolerance) were injected into the rotator interval. At a mean of 9 months, patients recorded their tolerance of the procedure, subsequent progress, the need for further treatment, and their current Oxford Shoulder Score. Results From 55 shoulders, six patients had a failure to improve and 10 patients had a transient improvement followed by recurrence (29%). 2/21 (9.5%) patients had 25 mL injected compared to 14/34 (41%) who had < = 20 mL ( p = 0.012). 14/43 (33%) of primary frozen shoulder patients had a recurrence, compared with 2/12 (16%) secondary frozen shoulder patients, p = 0.019. Conclusion Further treatment was indicated in 14/34 (41%) of patients who underwent hydrodilatation in the frozen stage of frozen shoulder and could not tolerate more than 20 mL of injection, and was more commonly required in primary (33%) versus secondary (16%) frozen shoulder.
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