Radiology Presentation 11107

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Radiology Presentation11/1/07

• Elisabeth Ferlic

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• Man is 40s presents with chronic dull low back
  pain and is found to have an elevated BUN/Cr, ESR
  and CRP

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Grainger 2001
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Retroperitoneal Fibrosis

• AKA
• Ormonds Disease
• Retroperitoneal fasciitits
• Chronic retroperitoneal fibroplasia
• Periureteritis plastica
• Sclerosing retroperitoneal granuloma

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Etiology

• An excessive deposition of extracellular matrix
  of unknown etiology
• 2/3 Primary/idiopathic -
• possibly an overzealous reaction to
  atherosclerotic changes or a manifestation of an
  autoimmune disease
• Secondary to medications, chronic inflammatory
  conditions, collagen vascular disorders,
  malignancy, radiation

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Presentation

• Dull low back pain
• Non-specific malaise, weight loss
• Depending on organ compressed
• Hypertension
• Constipation
• Renal insufficiency
• Jaundice

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CT - gold standard

• Narrowed and medially pulled ureters at L4-L5
• /- hydronephrosis
• Symmetric sclerotic mass surrounding
  non-displaced aorta or iliacs - equal
  attenuation to muscle
• No Bone involvement
• Retroperitoneal malignancy is more likely to
  shift the aorta anteriorly and ureters laterally

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Khan 2002
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Khan 2002
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IVP

• Useful for gauging degree of obstruction and
  planning intervention

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Khan 2002
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Khan 2002
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Treatment

• Surgical relief of obstruction
• Steroids
• Other Immune modulators

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References

• 1. Grainger RG, Allison DJ. Grainger and
  Allison's diagnostic radiology A textbook of
  medical imaging. 4th ed. London New York
  Churchill Livingstone 2001.
• 2. eMedicine - retroperitoneal fibrosis homepage
  on the Internet. cited 10/31/2007. Available
  from http//www.emedicine.com/radio/topic605.htm.
  
• 3. Tanagho E, McAninch J, editors. Smith's
  general urology, sixteenth edition. United
  States McGwaw Hill 2004.