Retroperitoneal fibrosis

Case contributed by Dr Michael P Hartung

Presentation

Evaluate retroperitoneal mass.

Patient Data

Age: 55 years
Gender: Male
CT

Circumferential soft tissue thickening involving the right internal iliac, bilateral common iliac arteries, and mid through distal abdominal aorta. Notice it surrounding the IMA. Both ureters are medialized but not obstructed. Aorta is not displaced anteriorly from the spine. No adenopathy. Transient small bowel intussusception left upper quadrant. 

Case Discussion

Typical findings of retroperitoneal fibrosis with circumferential soft tissue surrounding the aortic bifurcation, iliac vasculature and distal descending aorta. It typically starts near the bifurcation and ascends. It is helpful to observe the medialization of the ureters which confirms that this is a fibrosing process. The lack of elevation of the aorta or adenoapthy makes lymphoma very unlikely. This could be confirmed with CT-guided biopsy or checking igG4 levels (which if elevated would obviate the need for biopsy, but if negative would not exclude RPF).

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Case information

rID: 77205
Published: 7th May 2020
Last edited: 28th Dec 2020
System: Urogenital
Inclusion in quiz mode: Included

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