Abdo- retroperitoneum Flashcards
Where is the retroperitoneal space?
- area between posterior portion of the parietal peritonuem and the posterior abdominal wall muscles
- extends from diaphragm to the pelvis
retroperitoneal space lateral boundaries?
- boundaries extend to the extraperitoneal fat planes within the trandversalis fascia
the retroperitoneal space medially?
encloses the great vessels
retroperitoneal space 3 categories?
- anterior pararenal space
- perirenal space
- posterior pararenal space
borders of the retroperitoneum?
- superior
- inferior
- anterior
- posterior
- lateral
superior: diaphragm
inferior: pelvic rim
anterior: posterior parietal peritoneum
posterior: posterior abdominal wall muscle and spine
lateral: transversalis fascia and peritoneal portions of the mesentery
what is the anterior pararenal space?
the fat area between the posterior peritoneum and gerota’s fascia
what does the anterior pararenal space include? (5)
- pancreas
- descending portion of the duodenum
- ascending and descending colon
- superior mesenteric vessels
- inferior portion of the common bile duct
where is the perirenal space?
space separated from the pararenal space by gerota’s fascia
perirenal space includes?
- kidneys and adrenal glands
- perinephric fat
- ureters
- renal vessels
- aorta and IVC
- lymph nodes
posterior pararenal space is located where?
space between gerota’s fascia and the posterior abdominal wall muscles
posterior pararenal space includes?
- iliopsoas
- the posterior abdominal wall
- contains fat and nerves
SADPUCKER?
S= suprarenal (adrenal) glands A= aorta/ IVC D= duodenum P= pancreas U= ureters C= colon K= kidneys E= esophagus R= rectum
spaces in the retroperitoneum should be evaluated for? (4)
- lymphadenopathy
- neoplasms
- fluid collections
- ascites
division of abdominal lymph nodes (2)?
- parietal
- visceral
lymph nodes functions?
- filter the lymph of debris and organisms
- form lymphocytes and antibodies to fight infection
where are parietal nodes located?
- loacted in retroperitoneum
- surround aorta
what is parietal nodes subdivided into? (7)
- common iliac
- epigastric
- external iliac
- iliac circumfrence
- internal iliac
- lumbar
- sacral nodes
what drains into the paraaortic nodes?
kidney, adrenal gland, ovarian/testicular nodes
where are visceral nodes located?
- within peritoneum
- course along the vessels supplying the major organs
- generally located at the hilum of the organ
Normal or abnormal lymph node?
normal
normal or abnormal lymph node?
abnormal
sono appearance of normal lymph nodes?
- hypoechoic cortex
- hyperechoic fatty center
- smooth margins
- oval shape
- internal vascular blood flow especially at the hilum
- usually measures <1cm
sono appearance of abnormal lymph nodes?
- enlarged hypoechoic mass >1cm
- loss of hyperechoic fatty center
- displacement of adjacent structures
lymph nodes- infection?
smooth wall margins and oval shape typically caused by infection
abnormal lymph nodes malignant characteristics?
- irregular margins
- round shape
paraaortic lymph nodes sonographically?
- rounded
- focal
- echo-poor lesions
- > 1cm
- echo-poor masses
- often displace kidney laterally
paraaortic lymph node
what might a sonographer detect in paraaortic lymph nodes?
- mantle of nodes in paraspinal location
- floating or anteriorly displaced aorta
- mesenteric sandwich sign
what is the mesenteric sandwich sign?
- anterior and posterior node masses surrounding mesenteric vessels
splenomegly should be evaluated in patients with what?
lyphadenopathy
As gentle pressure is applied with the transducer in an effort to displace the bowel, the lymph nodes remain constant in shape T or F?
true
3 node regions?
periaortic
pericaval
intraaortocaval
lymph nodes associated pathology (3)?
- lymphoma
- renal carcinoma
- metastatic disease
non- vascular retroperitoneal pathology? (5)
- lymphadenopathy
- mesenteric adenitis
- metastatic disease
- benign masses
- retroperitoneal fibrosis
what is the most common primary retroperitoneal tumor?
lymphoma
Sonographic evaluation for abdominal lymphoma is performed to determine the presence or absence of?
- lymphadenopathy
lymphoma- main areas to be evaluated?
- hepatic and splenic hilum
- celiac and SMA
- paraaortic and renal hilum
lymphadenopathy
lymphoma accuracy of u/s?
- detection 90% when lymph nodes are >2cm in diameter
sono appearance of lymphoma?
ranges:
- round
- hypoechoic masses
- anechoic masses with posterior enhancement
Lymphoma
most common primary malignancies that spread into the retroperitoneum are from the? (3)
- breast
- lung
- testies
what usually indicates seeding or invasion of the peritoneal surface?
- ascites
- retroperitoneal tumor
Benign retroperitoneal masses?
Fibromas
Schwannomas
Neurofibromas
Lipomas
Fluid collections:
Hematoma
Urinoma , lymphocele
Abscess, pseudocyst
Retroperitoneal Fibrosis(Ormond’s Disease) is characterized by?
- an idiopathic condition characterized by thick sheets of fibrous tissue in the retroperitoneal cavity
fibrosis may encase and obstruct what?
- ureters and vena cava with resultant hydronephrosis
what is retroperitoneal fibrosis (Ormond’s disease) associated with? (4)
- infiltrating neoplasms
- acute immune diseases (crohn disease)
- ulcerative colitis
- sclerosing cholangitis
Retroperitoneal Fibrosis(Ormond’s Disease) clinically?
- abdominal pain
- hypertension
- oilgoanuria
Retroperitoneal Fibrosis(Ormond’s Disease) on ultrasound?
- abnormal hypoechoic tissue surrounding the anterolateral aspect of the aorta and/or the IVC
