Case of the Week: Retroperitoneal Fibrosis (Ultrasound & CT)

In this radiology lecture, we discuss the ultrasound and CT appearance of retroperitoneal fibrosis.

Key points include:

  • Most cases (70%) are idiopathic = Ormond disease.
  • Nonspecific symptoms depending on involved structures: Malaise, weight loss, low-grade fever.
  • Ureteral entrapment: Obstructive uropathy or renal failure, may see medial deviation of middle third of ureters with hydronephrosis.
  • Venous entrapment: Lower extremity edema, deep venous thrombosis.
  • CT: Soft tissue mass anterolateral to aorta with posterior sparing.
  • DDx: Retroperitoneal Lymphoma will Lift the aorta.
  • MRI: Low T1/T2 signal when inactive, T2 bright with early enhancement when active inflammation.
  • PET/CT: Avid when metabolically active, may aid in identifying appropriate biopsy sites.

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