Case Study - January 2011

A 72 year old man sent by his GP to the medical admission unit with few weeks history of bilateral flank pain, generalized malaise and loss of appetite. Initial blood tests by the GP showed serum Creatinine of 633 and an ESR of 120. Abdominal USS showed empty bladder with bilateral hydronephrosis. The patient then underwent a CT scan.

  1. What does the CT scan show?
  2. What is the vascular abnormality on the CT scan?
  3. What is the aetiology of this condition?
  4. What are the treatment options?

Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. Retroperitoneal Fibrosis. Note the fibrosis around the aorta leading to obstructed ureters and bilateral hydronephrosis.
  2. Abdominal Aortic Aneurysm.
  3. 70% of cases are idiopathic, The remainder 30% malignancy accounts for one third of it. The commonest malignancies are lymphoma and metastatic cancers of the breast, lung, pancreas and prostate. Other causes include previous
    radiotherapy, prolonged use of drugs such as Ergot compounds (Methysergides), Phenacetin and Beta blockers and chronic retroperitoneal infections like TB, Gonorrhea and Schistosomiasis.
  4. Urgent ureteric decompression either by ureteric stenting (see figure) or nephrostomies. Medical therapy may include Steroids, Tamoxifen, Azathioprin and Mycophenolate. Surgical therapy may involve ureterolysis (open or laparoscopic) together with omental wrapping and/or nephrectomy.

illustrative image for answer to question $n

The cookie setting on this website is set to ‘allow cookies’ to give you the very best experience.

If you continue without changing this setting, you consent to this - but if you want, you can change your setting at any time using the ‘change cookie setting’ link at the bottom of this page.

Cookie Setting







Our Cookies

Cookie NamePurpose
eu_ask This is used to store the cookie setting you set in the form above.
If you choose 'Do Not Allow Cookies' we will need to store this information as a cookie with the value N.
If you choose 'Allow Cookies' or do not make a choice, we will store this information as a cookie with the value Y.

The value is kept for one year.

3rd Party Cookies

Cookie NamePurpose
Google Analytics This website uses Google Analytics, a web analytics service provided by Google, Inc.
Google Analytics sets a cookie in order to evaluate your use of the website and compile reports for us on activity on the website.
Google stores the information collected by the cookie on servers in the United States.
Google may also transfer this information to third parties where required to do so by law,
or where such third parties process the information on Google's behalf.
Google will not associate your IP address with any other data held by Google
By using this website, you consent to the processing of data about you by Google in the manner and for the purposes set out above.

How to reject or delete this cookie

http://www.google.com/intl/en/privacypolicy.html