1/16. Imaging findings in idiopathic pelvic fibrosis.Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idiopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/16. Hypoplasia of the right hepatic lobe associated with portal hypertension and idiopathic retroperitoneal fibrosis.A 22-year-old man was referred to our hospital because of thrombocytopenia. Abdominal computed tomography (CT) revealed hypoplasia of the right hepatic lobe, the development of porto-systemic collateral vessels, splenomegaly and a periaortic soft-tissue mass. Laboratory tests and needle liver biopsy indicated no evidence of liver cirrhosis. Consequently, a diagnosis of hypoplasia of the right hepatic lobe associated with portal hypertension and idiopathic retroperitoneal fibrosis was established. Portal hypertension and hypersplenism was thought to be the cause of the thrombocytopenia. CT arterioportography revealed that anomalies of the portal venous system could have resulted in the hypoplasia of the right hepatic lobe. This is the first report describing hypoplasia of the right hepatic lobe accompanied by supervening idiopathic retroperitoneal fibrosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/16. Combined surgical intervention and medical management in a case of atypical idiopathic retroperitoneal fibrosis.Idiopathic retroperitoneal fibrosis (RPF) is one of the causes of obstructive uropathy. This disease, ever since its original description in 1948, has undergone much trial and error in its management. We present a case of a rare type of idiopathic RPF causing obstructive uropathy, which is perirenal and different from the classical RPF seen around the great vessels. To our knowledge, such a type of RPF has not been described. We treated the patient by a combined surgical approach in the form of ureterolysis and omentoplasty, followed by medical management with steroids and tamoxifen. The combined regimen yielded excellent results, and the patient is doing well at 9 months of follow up. The rarity of the presentation, with predominant bilateral perirenal fibrosis, and response of perirenal RPF to steroids and tamoxifen, is highlighted in this case presentation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/16. Late urologic complications in aorto-iliac reconstructions.Aortoiliac reconstructive hydroureteronephrosis after surgery may be due to an incorrect position of the .0.prosthesis, anteriorly to the ureter, to a reactive retroperitoneal fibrosis or to a sclerotic outcome caused by vessel and ureter dissection. It is important to consider the possible correlation of hydronephrosis with recurrent prosthetic infections, both as a consequence and as a pre-existing cause of the infective process itself. In the present study, 100 patients were examined, all affected with chronic peripheral obstructive arterial disease and operated on for aortoiliac reconstruction by the same surgeon. A clinical, laboratory and echographic study was performed, after a follow-up period from surgery ranging between 23 and 146 months (72 months on average). Four of them (4%) showed unilateral hydronephrosis, always asymptomatic and resulting from a retroperitoneal fibrosis. When hydronephrosis was moderate or severe, an intravenous pyelography was performed. Only one patient required ureterolysis and "wrapping" of the ureter with adipose tissue, and insertion of an indwelling ureteral catheter, due to marked hydronephrosis and a reduction in the diameter of contralateral kidney. From this retrospective study, the opportunity and the prognostic importance of a perspective study of the patients undergoing aorto-iliaco-femoral reconstruction for an obstructive or aneurysmal disease is evidenced.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/16. CT and MR imaging in the evaluation of retroperitoneal fibrosis.We have performed CT and MR on five patients with biopsy proven retroperitoneal fibrosis (RPF). Magnetic resonance (MR) accurately displayed a retroperitoneal mass of low signal intensity on T1-weighted scans and of heterogeneous medium signal intensity on T2-weighted scans. The coronal MR views demonstrated a retroperitoneal mass: the shape, signal intensity, and effects on the ureters and major vessels appear characteristic of RPF.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/16. Idiopathic peritesticular fibrosis associated with retroperitoneal fibrosis.A 32-year-old male who presented with idiopathic retroperitoneal fibrosis developed peritesticular fibrosis 4 years later. The lesion appeared as a diffuse, uniform thickening without a tendency to form nodules. Histologic examination revealed a densely collagenized tissue with scattered cells, consisting mainly of fibroblasts and plasma cells. Small blood and lymphatic vessels of the tumor showed luminal dilation and perivascular edema with inflammatory infiltrates. No other associated pathology was found in the patient. We suggest that peritesticular fibrosis in this patient may be due to lymphatic drainage obstruction caused by retroperitoneal fibrosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/16. retroperitoneal fibrosis with large-vessel obstruction. An uncommon vascular disorder.Five cases are presented in which retroperitoneal fibrosis had entrapped the inferior vena cava and/or aorta and caused occlusive vascular disease. The diagnosis was known preoperatively in two cases and was made at laparotomy in the others. The fibrosis in one case was caused by abdominal tuberculosis. In another case it was most probably secondary to an earlier trauma to the back. No cause could be established in the other three cases. CT scanning is valuable for identifying the lesion. Venous thrombectomy with arteriovenous fistula formation was successful in cases presenting with deep venous thrombosis.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
8/16. Idiopathic retroperitoneal fibrosis and primary biliary cirrhosis. A new association?We encountered a case of primary biliary cirrhosis in a nonalcoholic man who had been operated on for idiopathic retroperitoneal fibrosis 20 years previously. Chronic pancreatitis was also detected on endoscopic retrograde examination. After several episodes of digestive bleeding due to ruptured esophageal varixes, the patient died of massive hemorrhage. Postmortem examination showed stage 3 primary biliary cirrhosis and a thick retroperitoneal fibrous plaque, consisting of densely fibrotic areas of collagen with rare vessels and mononuclear cells. We suggest that idiopathic retroperitoneal fibrosis may be a new autoimmune disorder associated with primary biliary cirrhosis and that primary biliary cirrhosis is a potential cause of portal hypertension, cholestasis, or both in the course of idiopathic retroperitoneal fibrosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/16. Retractile mesenteritis: initial presentation as colonic obstruction.retroperitoneal fibrosis has been associated with a variety of sclerosing diseases. Among these is the variant known as retractile mesenteritis, which involves predominantly the mesentery of the small intestine and associated vessels; involvement of the mesocolon and the colon is less frequent. Two patients with a dominating clinical picture of colonic obstruction are described. The radiographic presentations were similar and should serve to remind radiologists and clinicians of this entity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/16. Pelvic lipomatosis.Although usually in the domain of the urologist, pelvic lipomatosis sometimes first may present to the general surgeon. Often called perivesical lipomatosis, this process of unknown etiology has been defined as a nonmalignant overgrowth of normal fatty tissue limited primarily to the perirectal and perivesical spaces in the pelvis. Typically it occurs in middle-aged, nonobese, men presenting with dysuria and sometimes with suprapubic fullness. High position of the prostate may be noted on rectal examination. urinary tract roentgenograms show a high, gourd-shaped bladder with the surrounding radiolucency of fatty tissues. Elongation of the urethra usually makes cystoscopy difficult. sigmoidoscopy and barium enema may reveal extrinsic pressure on the rectum. Pelvic venography rarely shows external venous compression; arteriography does not suggest neoplastic vessels. Fat metabolism studies are of little value. The absence of adequate cleavage planes renders direct surgical management difficult. The frequently progressive lower ureteral obstruction eventually may require urinary diversion. Four biopsy-proved cases from the Eastern virginia Medical School hospitals are reported, and the 57 previous cases from the literature are reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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