Department of Radiology, University of Szeged
Methods of examination:
• plain x-ray (radiography, fluoroscopy, tomography)
• x-ray with contrast material
• ultrasound (b-mode, Doppler, color, duplex)
• computed tomography
• magnetic resonance imaging
• x-ray-, US-, CT-guided intervention
• isotope
Department of Radiology, University of Szeged
Space occupying lesion I. (benign)
• hyperplasia (F/N)
• pseudotumor (N)
• bleeding (N): acute - > 40 HU, old - fluid-fluid level
• cyst, pseudocyst (N): 15 % calcified
• adenoma (F/N): 1-5 cm, <0 / 10 / <10 HU,
moderate enhancement, rarely calcified
• myelolipoma (N): fat density, moderate enhancement,
20 % calcified
F/N: function y/n
Department of Radiology, University of Szeged
Space occupying lesion II. (malignant):
• Medullary:
– pheochromocytoma
(paraganglioma) (F):
enhancement,
calcification, avoid
biopsy (?!)
– multiple endocrine
neoplasia (MEN) (F)
– neuroblastoma (N): 90
% calcified, > 5 cm
• Cortical:
– Adrenocortical
carcinoma (F/N): > 5
cm, heterogeneous
enhancement,
necrosis, bleeding, 50
% calcified
– metastasis (N):
heterogeneous
enhancement, bilateral,
irregular
– lymphoma (N)
F/N: function y/n
Department of Radiology, University of Szeged
Adenoma
Department of Radiology, University of Szeged
Pheochromocytoma
Department of Radiology, University of Szeged
Neuroblastoma
Department of Radiology, University of Szeged
Retroperitoneal lymphadenomegaly:
• malignant lymphoma
• lymphogenic metastasis
• inflammation, infection
• sarcoidosis
• amyloidosis
• Castleman disease
• Whipple disease
• HIV adenopathy
Department of Radiology, University of Szeged
Retroperitoneal lymphatic regions:
• retrocrural (lung, mesothelioma, lymphoma)
• pancreatico-duodenal (lymphoma, pancreas, colon, stomach,
lung, breast)
• periaortic-pericaval-interaortocaval (lymphoma, kidney, testicle, uterine cervix, prostate, ovary)
• celiac – superior mesenteric artery region (any abdominal tumor)
Department of Radiology, University of Szeged
Threshold value of largest axial lymph
node diameter
• retrocrural: > 6 mm
• pancreatico-duodenal: > 10 mm
• periaortic-pericaval-interaortocaval: > 10 mm
• celiac – superiopr mesenteric artery region: > 9 mm
Department of Radiology, University of Szeged
Limitation of detectability:
• US may be impeded by bowel gas and large body diameter
• CT & MR may be hampered by the lack of retroperitoneal fat
• US/CT/MR are not able to recognize pathologic changes in a normal
size lymph node
• most of lymphatic regions are unavailable for lymphography
Department of Radiology, University of Szeged
Limitations of characterisation:
• lymph nodes of normal size may harbor pathologic foci
• lymph node enlargement may be of benign or malignant
origin
• it may be difficult to differentiate enlarged lymph nodes
from cross-section of vessels/bowels by US/CT/MR
• filling defect detected by lymphography may be of
benign nature (fibrosis, fat)
Department of Radiology, University of Szeged
Diseases of the aorta
• atherosclerosis
• aneurysm (sclerosis, infection, injury)
– thrombosis
– dissection
– bleeding (chronic)
– bleeding (rupture)
• postoperative condition
Department of Radiology, University of Szeged
AAA rupture
3
4
Department of Radiology, University of
Szeged, Hungary
Department of Radiology, University of Szeged
Diseases of the IVC
• congenital anomalies
• thrombosis
• tumor thrombus
• external compression
• cava filter
Department of Radiology, University of Szeged
Retroperitoneal tumors:
Malignant
• fibrosarcoma
• malignant teratoma
• liposarcoma
• leiomyosarcoma
• rhabdomyosarcoma
• fibrous histiocytoma
• tumor of the kidney,
suprarenal gland,
pancreas
Benign
• haemangiopericytoma
• lymphangioma
• neurinoma
• teratoma
• Schwannoma
• fibrosus histiocytoma
• neurilemmoma
• lipoma
Department of Radiology, University of Szeged
Other retroperitoneal changes
• retroperitoneal fibrosis
• gas (perforation, emph. pyelonephr.)
• pseudocyst
• urinoma
• echinococcus cyst
• abscess (psoas!)
• haematoma
• lymphocele
• meningocele
• retrocaval ureter