Clinical History
68-year old gentleman
with history of acute pancreatitis 1 year ago. He is a non-drinker
and has history of ischaemic heart disease. A few months ago
he had bilateral loin pain with ultrasound showing bilateral
hydronephrosis. Subsequent ureteric stenting were done. He is
currently afebrile and has a normal blood count. No lymphadenopathy
is noted on examination.
Diagnosis:
Retroperitoneal fibrosis
Comment:
There is circumferential soft tissue density seen around the abdominal
aorta, extending beyond the aortic wall. The aorta is not dilated and the
renal arteries and SMA are patent but encased within this soft tissue mass.
Mild contrast enhancement is noted. There are stents inside the ureters
that are medially displaced. No fat stranding seen in the retroperitoneal
fat. No definite lesion seen in the lumbar vertebrae. There is mild
atrophic change in the pancreas. ) No ductal dilatation or calcification is
seen. Biopsy was performed after the episode of acute pancreatitis and
showed changes of auto-immune pancreatitis.
The patient has retroperitoneal fibrosis. This is likely to be the primary
form of the disease and has known association with other auto-immune
processes like pancreatitis, vasculitis, thyroiditis and fibrosing
mediastinitis. . He is not on any drug that is known to cause this
condition. There was also no sign of diseases that can result in secondary
retroperitoneal fibrosis which include lymphoma, metastasis, infection,
carcinoid or amyloidosis.
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