Retroperitoneal Fibrosis

Clinical History

33 years old man presented with 3 days history of right loin pain, rigor and dysurea. For the previous 3 months he experienced a dull discomfort on his right flank and back pain.

Imaging Findings

On examination he was pyrexial and had right loin tenderness. Basis blood investigation shows high ESR and deranged renal function. He had Ultrsound and IVU which showed hydronephrosis, medial displacement of the ureter and long segment involved.He later had a CT scan shows a plaque in the retroperitoneal lower one third of the ureter.

Discussion

Although Retroperitoneal Fibrosis is mostly idiopathic, recognised association with Abdominal Aortic Aneurysm. Some cases may be caused by certain drugs like mthysergide and B-Blockers. Less frequently it may be associated with malignant process and intraperitoneal inflamatory process such as Crohn disease. Management: Ureteric obstrucion could be transient resolving with control of the associated intraperitoneal disease, however initial management is to decompress the kidneys by nephrostomy or insertion of ureteric stent and treat the sepsis. Once the patient recovers from the sepsis then a careful search of a primary cancer should be undertaken. In the inflamatory cases steroid were reported to produce resolution of the process.If the obstrucion does not resolve medically then a surgical treatment to free the ureter. Rersponse to treatment is assessed by serial measurements of ESR and GFR supplemented by isotopic and imaging techniques including CT scans.

Differential Diagnosis List

Final Diagnosis

Retroperitoneal Fibrosis

URL:	https://www.eurorad.org/case/4142
DOI:	10.1594/EURORAD/CASE.4142
ISSN:	1563-4086