BOF: 13
A 56-year-old male presents
with pain in the lower back. The pain has a girdle like distribution beginning
in the lower back and radiating to the lower abdomen. He has not been on any
drugs. The patient is hypertensive but there are no other physical signs of
note. Investigations reveal a normocytic normochromic anaemia, raised
erythrocyte sedimentation rate and C-reactive protein. Renal function is
impaired. Ultrasound scanning reveals bilateral hydronephrosis.
Which of the following investigations is most likely to give you the
diagnosis?
a) Intravenous urogram
b) Retrograde urogram
c) Isotope renogram
d) Computerised tomogram of abdomen
e) Renal biopsy
Answer:
d)
The patient has idiopathic
retroperitoneal fibrosis (peri-aortitis).
This is a condition in which the ureters become embedded in dense fibrous
tissue, usually at the junction of the middle and lower thirds of the ureters.
This results in unilateral or bilateral ureteric obstruction.
CT scanning will show a peri-aortic mass.
Histological confirmation is obtained by CT guided biopsy or laparotomy
