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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