Monday, May 29, 2017

Rind-like Perirenal Soft-Tissue Masses


Rind-like perirenal soft tissue masses: Retroperitoneal fibrosis

Differential diagnosis for rind-like perirenal soft-tissue masses:
  • Lymphoma (and Waldenstrom Macroglobulinemia)
    • Usually due to contiguous spread from retroperitoneal or renal lymphoma: Distinct imaging patterns: multiple masses, solitary mass, diffuse infiltrating mass, rindlike soft-tissue thickening, and direct invasion from adjacent retroperitoneal lymphadenopathy
    • Isolated perirenal lymphoma very unusual (<10% of cases): Uniformly attenuating rindlike soft-tissue mass.
    • Does not necessarily affect renal function.
  • Erdheim-Chester disease
    • Rindlike soft-tissue lesions surrounding the kidneys and ureters
    • Severe compression of renal parenchyma and ureters leads to progressive renal failure
    • Percutaneous nephrostomy made difficult because due to fibrous perinephritis.
  • Retroperitoneal Fibrosis (shown above)
    • Typically localized to infrarenal aorta and common iliac arteries
    • Isolated or related to multifocal fibrosclerosis (may include autoimmune pancreatitis, sclerosing cholangitis, scleroderma, Riedel thyroiditis, fibrotic pseudotumor of the orbit, and fibrosis involving multiple organ systems).
    • Perirenal involvement can be from extension from retroperitoneal fibrosis, without associated retroperitoneal fibrosis, or one of manifestations of multifocal fibrosclerosis
    • Perirenal involvement: Soft-tissue mass enveloping kidneys without displacing them.

References

Surabhi VR, Menias C, Prasad SR, Patel AH, Nagar A, Dalrymple NC. Neoplastic and non-neoplastic proliferative disorders of the perirenal space: cross-sectional imaging findings. Radiographics. 2008 Jul-Aug;28(4):1005-17.

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