Findings: This CT of the abdomen demonstrates a very large multiseptated cystic mass involving the majority of the abdomen.

Diagnosis: Mesenteric lymphangioma.

Discussion: The most common type of mesenteric or omental cystic structure is the lymphangioma, followed by a nonpancreatic pseudocyst, duplication cyst, mesothelial cyst, and enteric cyst. A lymphangioma is a congenital malformation of lymphatics that occasionally occurs in the mesentery but may also occur in the neck, mediastinum, and axilla. Approximately 65% of these patients present at birth with approximately 90% presenting by 2 years of age. The usual symptoms include abdominal distention and small bowel obstruction. Lymphangiomas are large, thin-walled cystic structures that are usually multiloculated. The fluid may be serous chylous, or occasionally hemorrhagic. Sonographically, lymphangiomas are generally multiseptated anechoic masses which may contain internal echoes if hemorrhagic. CT demonstrates a multiseptated mass of fluid (or rarely fat) attenuation.

References:
Stoupis C. Bubbles in the Belly: Imaging of Cystic Mesenteric
or Omental Masses. Radiographcis;14:729-737.

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