Answer of October 2006

Clinical History:

68-year old gentleman with history of acute pancreatitis 1 year ago. He is a non-drinker and has history of ischaemic heart disease. A few months ago he had bilateral loin pain with ultrasound showing bilateral hydronephrosis. Subsequent ureteric stenting were done. He is currently afebrile and has a normal blood count. No lymphadenopathy is noted on examination.

Diagnosis:

Retroperitoneal fibrosis

Discussion:

There is circumferential soft tissue density seen around the abdominal aorta, extending beyond the aortic wall. The aorta is not dilated and the renal arteries and SMA are patent but encased within this soft tissue mass. Mild contrast enhancement is noted. There are stents inside the ureters that are medially displaced. No fat stranding seen in the retroperitoneal fat. No definite lesion seen in the lumbar vertebrae. There is mild
atrophic change in the pancreas. ) No ductal dilatation or calcification is seen. Biopsy was performed after the episode of acute pancreatitis and
showed changes of auto-immune pancreatitis. 

The patient has retroperitoneal fibrosis. This is likely to be the primary form of the disease and has known association with other auto-immune processes like pancreatitis, vasculitis, thyroiditis and fibrosing mediastinitis. . He is not on any drug that is known to cause this condition. There was also no sign of diseases that can result in secondary retroperitoneal fibrosis which include lymphoma, metastasis, infection, carcinoid or amyloidosis.