Retroperitoneum Flashcards
What are the borders of the retroperitoneum?
Parietal peritoneum (anterior)
Transverse fascia (posterior)
Diaphragm
Pelvic floor
What organs are held in the retroperitoneum?
Aorta IVC Pancreas Kidneys and adrenals Lymph nodes Crura and psoas muscles Uterus
Which are the compartments of the retroperitoneum?
ARP - Anterior pararenal
PR - perirenal
PPR - post-pararenal
Indications for retroperitoneum imaging
Pulsatile abdominal mass Fever of unknown origin Unexplained decreased hematocrit Possible renal mass Possible lymphoma or retroperitoneal fibrosis
Where are lymph nodes located?
Near the groin Axilla Neck Aorta Porta hepatis
What is the best landmark to identify the retroperitoneum?
Gerota’s fascia
Lymph adenopathy etiology
Infection
Malignancy
Allergic reactions
Typical locations of lymph adenopathy
Inguinal region Neck The mesentary *forms the sandwich sign with SMA Renal hilum Aorta
Sonographic features of malignant nodes
Hypoechoic or anechoic
Some may be hyperechoic or calcified
Which is the most common soft tissue tumor of the retroperitoneum?
Liposarcoma
Fast growing smooth muscle malignant tumor
Leiomyosarcoma
Where does Leiomyosarcoma reside?
In the uterus or GI tract
Grows rapidly and METS to the lungs
What kind of lymphomas are there?
Hodgkin Disease: primary
Non-Hodgkin disease: secondary
Characteristics of Hodgkin lymphoma
Chronic enlargement of lymph nodes
Local at the onset than later generalized
Hepatosplenomegaly
No pronounced leukocytosis (WBC not affected)
Anemia
Fever
Sonographic appearance of Hodgkin lymphoma
Hypoechoic enlarged lymph nodes > 1 cm
What is Non-Hodgkin’s disease lymphoma?
Secondary lymphoma Anything other than Hodgkin's disease Mets Primary tumor spreads to lymphatics Lymphatic dissemination Common primary cancer Testicular cancer Breast cancer Lung cancer Skin cancer
Sonographic findings of Non-Hodgekin’s lymphoma
Floating aorta sign
Enlarged lymph nodes
Aorta can be displaced anteriorly
What is retroperitoneal fibrosis?
Formation of fibrous tissue as a reparative or reactive. Causing abnormal thickening and scarring of connective tissue most often following injury, infection, lack of oxygen or surgery.
Proliferation of retroperitoneal connective tissue
Causes of retroperitoneal fibrosis
50% idiopathic
Inflammatory
Low grade infections
Ergot medications for migraine
Clinical presentation of retroperitoneal fibrosis
Abdominal pain
Back pain
Flank pain
Oliguria
Sonographic appearance of retroperitoneal fibrosis
Hypoechoic mass enveloping over aorta, IVC and extends down to sacrum
MENTLE EFFECT
No aortic displacement
Smooth bordered
Typical location of hematoma in retroperitoneum
Psoas muscle *most common in hemophiliacs
Around kidneys
Causes of hematomas in retroperitoneum
Trauma
Surgery
Anticoagulant therapy
Bleeding problems such as hemophilia
Clinical presentation of hematomas in retroperitoneum
Local pain
Transient fever
Hematocrit drop
Sonographic findings of hematomas
Hypoechoic
Echogenic
Which is the 4th most common site for METS after lungs, liver and bone?
Adrenal glands
What is the “headlight sign”?
METS to both adrenal glands forming large, bilat, hypoechoic masses from Bronchogenic lung carcinoma
