Retroperitoneum and Lymphatic system Ch. 14 Flashcards
A pocket of infection typically containing pus, blood, and degenerating tissue
Abscess
Enlargement of lymph nodes due to inflammation, primary neoplasia, or metastasis. Also called lymphadenopathy
Adenopathy
Fluid, such as blood, bile, or urine, that is forced out or leaks out of its normal vessel into the surrounding tissues or potential spaces
Extravasate
A thin sheet-like tissue that separates muscles
Fascia
A term used to describe the aorta and inferior vena cava together
Great vessels
An extravasated collection of blood localized within a potential space or tissues
hematoma
Human immunodeficiency virus; blood-borne virus that attacks T lymphocytes resulting in their destruction or impairment eventually leading to AIDS
HIV
Distortion or displacement of normal anatomy due to a mass, neoplasm, or fluid collection
Mass effect
The spread of cancer from the site at which it first arose to a distant site
Metastasis
Planes that are perpendicular or 90 degrees to each other
Orthogonal
A new growth of benign or malignant orgin
Primary neoplasm
An extravasated urine collection due to a tear of the urinary collecting system
Urinoma
Extravasated lymphatic fluid within the retroperitoneum
Lymphocele
Primary modality for evaluating the retroperitoneal cavity
CT
What lymph nodes are located surrounding the major blood vessels of the retroperitoneum?
Parietal lymph nodes
What lymph nodes are located along the small bowel and mesentery?
Lacteals
What is the most common primary malignancy of the retroperitneum?
Liposarcoma
What is the sonographic appearance of a liposarcoma?
Extremely large, poorly marginated, complex retroperitoneal mass
What is the most common site for retroperitoneal infections?
Anterior pararenal space
What is the most common cause of posterior pararenal fluid collections?
Abscess or hemorrhage from aortic disease
The area that lies behind the peritoneal membrane is referred to as the
Retroperitoneum
The retroperitoneum lies between the pariteal peritoneum and anterior to the
Transverse facia
Lymph nodes are located 360 degrees around the great vessels. The nodes that lie posterior to the great vessels may displace the aorta and IVC ______________ when enlarged
Anteriorly
A fluid collection that may occur following lymph node dissection for cancer staging
Lymphocele
Retroperitoneal fluid collections include:
Abscess
Hematoma
Urinoma
Lymphocele
Fluid collections within the perirenal space are generally associated with ______________ abnormalties
Renal
An enlargement of lymph nodes due to an inflammatory process is called
Lymphadenitis
The second most common primary retroperitoneal malignancy is
Leiomyosarcoma
Malignant tumors tend to be ____________ and more ___________ than their benign counterparts.
Larger
Complex
Three major compartments of the retroperitoneum
Anterior pararenal space
perirenal or perinephric space
Posterior pararenal space
The anterior pararenal space is bordered anteriorly by the ________ ________ __________ and posteriorly by the ___________ __________ ____________.
posterior parietal peritoneum
anterior perirenal fascia
The perirenal space is bordered anteriorly by the __________ __________ __________ and posteriorly by the _________ ___________ ___________.
anterior renal fascia
posterior renal fascia
The posterior renal space lies between the _________ __________ ___________ and the ___________ ____________ .
posterior renal fascia
transversalis fascia
Solid masses found in the retroperitoneum are usually __________ and most frequently involve the _________ ___________.
Metastatic
Lymph nodes
On color or power doppler, lymphadenitis demonstrates
hyperemia
Primary malignant nodes tend to become more ___________ to ___________ and round shaped with a length to width ratio of less than two
hypoechoic
anechoic
_______________ is a very common finding in patients with acquired immune deficiency syndrome (AIDS)
Lymphadenopathy
Chronic inflammatory process that results in fibrous tissue proliferation affecting and encasing the great vessels, ureters and lymphatics of the retroperitoneum
Retroperitoneal fibrosis
Primary malignancies of the retroperitoneum include
Liposarcoma
leinmyosarcoma
rhabdomyosarcoma
myxosarcoma
fibrosarcoma
Most common primary malignancy of the retroperitoneum, representing 95% of all fatty retroperitoneal tumors
Liposarcoma
Most common site for retroperitoneal infections
Anterior pararenal space
Sonographically, enlarged lymph nodes typically appear as
oval to round shaped masses with a low to medium level echo pattern.
Sonographically primary malignant nodes tend to be
more hypoechoic to anechoic , more round than oval in shape, asymmetric cortical widening and loss of normal fatty hilum
A distortion or displacement of normal anatomy due to a mass, neoplasm or fluid collection
Mass effect
Which retroperitoneal space contains no organs?
Posterior pararenal space
What are lymph nodes that are found surrounding the major blood vessels of the retroperitoneum?
Parietal lymph nodes
What are lymph nodes found along the small bowel and mesentery called?
Lacteals
What is the most common cause of posterior pararenal fluid collections?
Abscess or hemorrhage from aortic disease
Which retroperitoneal compartment would contain a pseudocyst?
Anterior pararenal space
A fluid collection is seen surrounding the left kidney. What is the likely diagnosis of the fluid collection?
Urinoma
What is the normal measurement for lymph nodes surrounding the great vessels
Less than 10 mm
Which retroperitoneal compartment contains the psoas and quadrates lumborum muscles?
Posterior pararenal space
Sonographic findings of retroperitoneal fibrosis
Large, hypoechoic mass surrounding the abdominal aorta
Indicate the two primary functions of lymph nodes
Filter lymph
Immune Surveillance
What structures functions to filter lymph
Lymph nodes
Lymphatic ____________ drain into the subclavian veins
Ducts
What cell type has receptors on their surface that enables them to recognize nonself antigens
Lymphocytes
Malignant smooth muscle tumors in uterus & GI tract
Leiomyosarcomas
Dense, fibrous sheets of connective tissue extending from perirenal space to dome of bladder
Retroperitoneal Fibrosis (RPF) aka Ormond’s Disease or Inflammatory Aneurysm
Best diagnostic tool for Cystic Masses / Retroperitoneal Fluid Collections is?
FNA
Abscess presents with:
Leukocytosis
Fever
Point tenderness (depending on location)
Urinoma is due to
Trauma
Obstruction
Renal Transplant
Sonographic appearance of benign lymph node pathology is
Echogenic lymph node with fatty hilum
Adenopathy is secondary to lymphoma is usually_________ in appearance
Sonolucent
Adenopathy secondary to metastatic disease is usually ______________
Complex
The fluid that enters the lymphatic plexus is referred to as
Lymph
In the retroperitoneum , lymph nodes are usually divided into
deep abdominal (or parietal) lymph nodes
Superficial abdominal (or Visceral) lymph nodes
Lymph nodes encircling the aorta or IVC or both are considered abnormal in size if they are greater than
> 10
The anterior pararenal space contains portions of the
Digestive tract
The pancreas
Distal common bile duct
The perirenal space contains the:
kidneys
adrenal glands
perinephric fat
aorta
IVC
The posterior pararenal space contains
No organs, only fat
Retroperitoneal infections most commonly occur in the _______________ _________________ space as a result of appendicitis, bowel inflammation, trauma or pancreatitis
Anterior pararenal
Fluid collections in the _____________ ______________ are generally associated with renal abnormalites such as nephritis, ruptured renal artery aneurysm, or bleeding from a renal neoplasm
Perirenal space
Fluid collections in the _____________ ____________ space are most commonly associated with aortic disease and may include hemorrhage from rupture or infection from surgical procedures
Posterior pararenal
Which retroperitoneal compartment contains the pancreas, the ascending colon, and the descending colon?
Anterior Pararenal Space
Which lymphatic nodes are located in the retroperitoneum?
Mesenteric
What pathology describes the enlargement of lymph nodes caused by inflammation , primary neoplasia, or metastasis?
Lymphadenopathy(Adenopathy)
Which echo pattern is usually seen with primary malignant nodes like those seen with lymphoma?
Round shaped, hypoechoic to anechoic
What is the extent of the retroperitoneum?
From the diaphragm superiorly to the pelvic brim inferiorly
What is the primary difference int he sonographic appearance between retroperitoneal firosis and para-aortic lymphadenopathy?
Renal fascia is less echogenic and ssmaller
