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

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