The answer to the Image Quiz by Dr. Wisit Cheungpasitporn is retroperitoneal fibrosis.
This is a 70-year-old man with weight loss, bilateral flank pain and progressive lower back pain for a month. This image is a CT of the abdomen.
What is the likely diagnosis?
(Hint – IgG4 Related systemic disease)
Explanation
CT of the abdomen demonstrated circumferential soft tissue
density surrounding the aorta, hydroureter and mild hydronephrosis bilaterally.
Most likely diagnosis
is retroperitoneal fibrosis.
Retroperitoneal fibrosis is a rare disease, characterized by
the development of extensive fibrosis throughout the retroperitoneum leading to
obstruction of retroperitoneal structures, particularly the ureters.
Retroperitoneal fibrosis is most often idiopathic, but the associations of
retroperitoneal fibrosis with drugs, infections and malignancies have been
implicated. The human leukocyte antigen (HLA)-B27 cell marker and elevated
immunoglobulin G4 (IgG4) level and abundant IgG4-rich plasma cells in the inflammatory
infiltrate have been demonstrated.
(Courtesy of Dr. Wisit Cheungpasitporn; email: wisit.cheungpasitporn@bassett.org).
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The answer to the Image Quiz 4/2/12 is renal cell cancer. The right kidney and the gall bladder (*) are involved - the latter with metastatic disease.
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The answer to the Image Quiz 4/2/12 is renal cell cancer. The right kidney and the gall bladder (*) are involved - the latter with metastatic disease.
This is a 66 year old woman with microscopic hematuria. The image is a CT of the abdomen.
What are the abnormalities (there are two) and what is the likely diagnosis?
