Ultrasonic Diagnosis Of Retroperitoneal Fibrosis

Objective:To recognize the knowledge of retroperitoneal fibrosis deeply. In order to develop the diagnostic ability of ultrasound, we investigate the ultrasonographic characteristics of RPF and induce main points of differential diagnosis.Method:Patients who see the doctor by hydronephrosis without reason certainly received ultrasound examination. In the end, there were43patients enter the investigation. Among these patients,13were confirmed by pathology and others are diagnosed clinically as retroperitoneal fibrosis. All of them record their symptoms, positive physical examination, laboratory examination results, the other imaging manifestations, treatment and curative effect. Emphasize the ultrasonographic features and main points of differential diagnosis.Results:①There were43patients, the ratio of male to female was30:13. The patients’ age was28～78years and the mean duration between the onset of the disease and making right diagnosis was3weeks～19.5months.②14patients have history of using special drugs, external injury, chronic inflammation and malignant tumor. The others were considered as idiopathic retroperitoneal fibrosis (IRPF).③The commonest complains and physio-chemical examination result was back, flank or abdominal pain and elevation of ESR.④All patients received ultrasound examination and retroperitoneal lesion was observed only in62.8%of them. The features were hypo or dense echoic mass which may be generalized,localized or cord-like around aorta and inferior vena cava without definite margin and blood flow. All patients were observed hydronephrosis. Both of kidneys accumulate water in27patients.16patients were observed hydronephrosis in left or right kidney only. However, hydronephrosis was the only symptom in37.2%of the patients. Kidney and blood vessel involvement were found in20.9%and27.9%of the patients. Kidney’s involvement show in more powerful parenchyma echo or smaller volume of renal. Abdominal aorta and inferior vena cava can be compress by fibrous plaque.⑤in the same time, plain CT scanning and enhanced CT scanning were performed in all cases. Hypodensity, inhomodensity or isodensity diffuse lesions were showed in27cases and well circumscribed masses in15cases, and various enhancements were showed by enhanced scanning.1case was discovered hydronephrosis and hydroureterosis only.Conclusion:①Retroperitoneal fibrosis (RPF) is a very rare disease and it has no specific manifestation. It is difficult to diagnosis before surgery.②The disease is characterized by periaortic soft tissue mass and hydronephrosis in ultrasonography, furthermore, ultrasound is also useful in the evaluation of follow-up curative effect. To sum up, ultrasonography has a great value in clinical practice.③Furthermore, we should differentiate RPF from some other diseases such as abdominal aortic aneurysm with parietalthrombus, lymphoma, lymphatic metastasis and polyarteritis④But it depends a lot on the examiner. So the sensitivity of ultrasound is lower than the detection of CT.⑤RPF should be considered when hydronephrosis and dilatation of the ureter is found without certainly reason, especially with ureter shift to center. We must sweep carefully at retroperitoneum in order to elevate the sensitivity of ultrasonography.⑥Ultrasonography is not only an effective imaging method in diagnosing RPF, but also is useful in evaluation of clinical treatment and following up of RPF.