Figure 850

A-H, Idiopathic retroperitoneal fibrosis: computed tomography scans of the abdomen before (left panels, note right ureteral stent and mild left ureteropyelocaliectasis) and 7 years after ureterolysis (right panels, note omental interposition). Retroperitoneal fibrosis is characterized by the accumulation of inflammatory and fibrotic tissue around the aorta, between the renal hila and the pelvic brim. Most cases are idiopathic; the remainder are associated with immune-mediated connective tissue diseases, ingestion of drugs such as methysergide, abdominal aortic aneurysms, or malignancy. Idiopathic retroperitoneal fibrosis can be associated with mediasti-

nal fibrosis, sclerosing cholangitis, Riedel's thyroiditis, and fibrous pseudotumor of the orbit. In the clinical setting, patients with idio-pathic retroperitoneal fibrosis exhibit systemic symptoms such as malaise, anorexia and weight loss, and abdominal or flank pain. Renal insufficiency is often seen and is caused by bilateral ureteral obstruction. Laboratory test results usually demonstrate anemia and an elevated sedimentation rate. The treatment is directed to the release of the ureteral obstruction, which initially can be achieved by placement of ureteral stents. Administration of corticosteroids is helpful to control the systemic manifestations of the disease and

(Continued on next page)

0 0

Post a comment