69 Retroperitoneal Fibrosis

Clinical Presentation

A 65-year-old man complains of a dull back pain.

Fig. 69.1 (A,B) Axial contrast-enhanced CT images show diffuse bilateral soft tissue infiltration of the perirenal space extending into the renal hilum with evidence of hydronephrosis. There is also plaquelike thickening surrounding the aorta and the medial aspect of the inferior vena cava.

Radiologic Findings

Axial contrast-enhanced computed tomography (CT) images show diffuse bilateral soft tissue infiltration of the perirenal space extending into the renal hilum with evidence of hydronephrosis. There is also plaquelike thickening surrounding the aorta and the medial aspect of the inferior vena cava (IVC) (Fig. 69.1).

Diagnosis

Retroperitoneal fibrosis (RPF)

Differential Diagnosis

Retroperitoneal malignancies
Retroperitoneal lymphoma
Retroperitoneal hemorrhage, infection, amyloidosis

Discussion

Background

RPF is a relatively uncommon clinical entity, predominantly affecting men in their 4th to 6th decade. This disorder is characterized by the development of extensive fibrosis occurring throughout the retroperitoneum, ultimately leading to encasement and entrapment of retroperitoneal structures. RPF usually begins at the level of the fourth and fifth lumbar vertebrae and subsequently spreads cephalad, encasing the aorta, IVC, and ureters.