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Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know

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Abstract

Retroperitoneal soft tissue lesions represent a wide range of disease processes with overlapping imaging findings. Familiarity with the CT and MR characteristics of these conditions is important to guide clinical evaluation. We review the tissue types, characteristic clinical, demographic, and imaging features of retroperitoneal tumors and tumor-like non-neoplastic conditions with CT and MR correlation, including anatomic and imaging clues, and provide a diagnostic approach to aide the radiologist in making a specific diagnosis.

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Acknowledgements

The authors thank Henry Douglas for his help with images.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA

    Ferenc Czeyda-Pommersheim, Annemarie Boustani & Margarita Revzin

  2. Department of Radiology, Mayo Clinic, Phoenix, AZ, USA

    Christine Menias

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  1. Ferenc Czeyda-Pommersheim
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Video 1: Follicular Lymphoma in a 38-year-old female. Coronal reconstruction of a contrast enhanced abdomen CT cine clip show a large confluent nodal mass (arrows) in the retroperitoneum and the mesenteric root. Note the relatively homogenous (for the size of the nodal mass) contrast enhancement and contiguous but discrete enlarged lymph nodes in the mesentery. The retroperitoneal mass splays and narrows but doesn’t obstruct the right main renal artery (RMRA) and the left main renal artery (LMRA). Supplementary Material 1 (AVI 409318 kb)

Video 2 a,b: Paraganglioma in a 54-year-old male with retroperitoneal mass. A. Axial contrast enhanced CTcine clip shows a heterogeneous but predominantly markedly enhancing mass (M) in the retroperitoneum adjacent to the left kidney and adrenal gland. B. F-18 FDG Body PET-CT fusion cine clip obtained in axial plane demonstrates a very intense uptake in the locally invasive left retroperitoneal mass (SUVmax 26.3, image 145), consistent with malignancy. Supplementary Material 2 (AVI 174740 kb)

Video 3: Germ Cell tumor with retroperitoneal metastases in a 52-year-old male. Coronal T2W MRI cine clip of the abdomen and pelvis shows a large, confluent heterogeneous hyperdense to the skeletal muscle nodal mass (arrows) causing significant displacement of the left kidney (LK) and narrowing of the retroperitoneal vasculature most pronounced of the left renal vein. Note large well-circumscribed primary germ cell tumor in the scrotum. Multiple simple renal cysts are also present. Supplementary Material 3 (AVI 131472 kb)

Supplementary Material 4 (AVI 278170 kb)

Video 4 a, b: Presacral Epidermoid in a 29-year-old female with complex pelvic cyst. A. Sagittal T2 TSE cine clip shows a well-circumscribed lesion (M) with a T2 hypointense wall and T2 hyperintense internal contents in the presacral tissues. The contents are markedly T2 hyperintense due to gross fat. B. Axial T1W FS post-contrast image of the pelvis shows a cystic lesion (M) with a thin, enhancing wall and no internal enhancing components in the presacral tissues. Note that on the fat saturated image the cyst contents show complete signal loss due to gross fat content. Supplementary material 5 (AVI 197048 kb)

Supplementary Material 6 (AVI 371462 kb)

Video 5: Retroperitoneal fibrosis in a middle-aged woman. Contrast-enhanced T1 weighed fat suppressed axial image through the abdomen and pelvis shows enhancing soft tissue encircling the aorta (yellow arrows). Although less noticeable the ureters also were involved resulting in enhancing tissue thickening of the ureteral wall (green arrows) and resulting in ureteral obstruction for which bilateral nephroureteral stents (seen as signal void within the ureter lumen) were placed. The soft tissue tethers the right ovary (red arrow) which is anteriorly displaced. Supplementary material 7 (AVI 116773 kb)

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Czeyda-Pommersheim, F., Menias, C., Boustani, A. et al. Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know. Abdom Radiol 46, 1062–1081 (2021). https://doi.org/10.1007/s00261-020-02752-8

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