Kobayashi Hiroshi, Notohara Kenji, Otsuka Tadashi, Kobayashi Yuka, Ujita Masuo, Yoshioka Yuuki, Suzuki Naomasa, Aoyagi Ryuji, Ohashi Riuko, Suzuki Toshimitsu
Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan.
Department of Pathology, Kurashiki General Hospital, Kurashiki, Okayama, Japan.
Am J Case Rep. 2018 Jan 4;19:13-20. doi: 10.12659/ajcr.905744.
BACKGROUND Mesenteric panniculitis (MP) is an idiopathic chronic inflammatory condition of the mesentery. The main symptoms include abdominal pain, abdominal distention, weight loss, fever, nausea, and vomiting. The patients also present with chylous ascites in 14% of the cases and chylous pleural effusion (CPE) in very rare occasions. Despite the previous view of excellent prognosis of MP, two recent papers reported several fatal cases. However, there are still only a few autopsy case reports that describe the macroscopic and histological details of MP cases. CASE REPORT The patient was an 81-year-old Japanese woman. She complained of edema of her lower legs and face, general fatigue, and dyspnea. She was overweight and had type 2 diabetes (T2D). Computerized tomography (CT) demonstrated massive bilateral pleural effusions, with mild pericardial effusion and mild ascites. There was no pulmonary, cardiac or hepatic condition to explain the effusions. However, MP was suspected based on her CT. She gradually deteriorated into respiratory failure. The autopsy revealed CPEs (left 1,300 mL, right 1,400 mL) and MP in the mesentery of the small intestine. Neither neoplasia nor inflammatory conditions other than MP were detected. CONCLUSIONS In rare occasions, patients with MP present with CPE or chylothorax. We thought that a possible mechanism of the CPEs was a diaphragmatic defect. We suspected that being overweight and T2D had an etiological relationship with MP in our patient's case. Adipose tissue of the mesentery is the main focus of MP. We believed that MP would be the best umbrella term of the many synonyms.
肠系膜脂膜炎（MP）是一种肠系膜特发性慢性炎症性疾病。主要症状包括腹痛、腹胀、体重减轻、发热、恶心和呕吐。14%的患者还会出现乳糜性腹水，极少数情况下会出现乳糜性胸腔积液（CPE）。尽管之前认为MP预后良好，但最近两篇论文报道了几例致命病例。然而，目前仍只有少数尸检病例报告描述了MP病例的大体和组织学细节。病例报告：患者为一名81岁的日本女性。她主诉小腿和面部水肿、全身乏力和呼吸困难。她超重且患有2型糖尿病（T2D）。计算机断层扫描（CT）显示双侧大量胸腔积液，伴有轻度心包积液和轻度腹水。没有肺部、心脏或肝脏疾病可以解释这些积液。然而，根据她的CT怀疑为MP。她逐渐恶化为呼吸衰竭。尸检发现CPE（左侧1300 mL，右侧1400 mL）以及小肠系膜中的MP。未检测到除MP以外的肿瘤或炎症性疾病。结论：在极少数情况下，MP患者会出现CPE或乳糜胸。我们认为CPE的一种可能机制是膈肌缺损。我们怀疑在我们的患者病例中，超重和T2D与MP存在病因学关系。肠系膜脂肪组织是MP的主要病变部位。我们认为MP是众多同义词中最合适的统称。
