Retroperitoneal Fibrosis
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Jennifer Conard
A 50-year-old man with type 2 diabetes mellitus, nonalcoholic fatty liver disease, and sarcoidosis presented to the emergency department with lower abdominal pain for the past 3 months. Physical examination revealed suprapubic discomfort, back pain, stress-induced incontinence, abdominal distention, and scrotal swelling. A computed tomographic angiogram of the abdomen and pelvis showed progressive, circumferential, periaortic internal iliac soft tissue swelling (image A, arrow). Laboratory test results confirmed elevated levels of C-reactive protein and serum complement C3 and C4. A venacavogram showed high-grade infrarenal inferior vena cava stenosis (image B, arrow). The patient was admitted to the hospital and given 1 mg of intravenous methylprednisolone for 3 days. A stent was placed, and the patient was discharged 6 days later. Oral prednisone was prescribed, beginning at a dose of 60 mg and decreasing by 10 mg every 3 weeks. One month after discharge methotrexate was prescribed (5 mg every 12 hours, 1 time weekly) and the patient's symptoms improved.
Retroperitoneal fibrosis is rare, and more than two-thirds of cases are idiopathic.1 Computed tomographic and magnetic resonance images can reveal soft-tissue swelling surrounding the abdominal aorta and iliac arteries, with possible encasement of neighboring structures.2 Management consists of immunosuppressants aimed at inactivation of acute-phase reactants and relapse prevention.2,3 Relapses and progression to end-stage renal disease can be minimized by close follow-up and patient adherence to medication.3
References
1. Vaglio A , SalvaraniC, BuzioC. Retroperitoneal fibrosis. Lancet. 2006;367(9506):241-251.10.1016/S0140-6736(06)68035-5Suche in Google Scholar
2. Vaglio A , PalmisanoA, AlbericiF, et al. Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomized controlled trial. Lancet. 2011;378(9788):338-346. doi:10.1016/S0140-6736(11)60934-3Suche in Google Scholar
3. Kermani TA , CrowsonCS, AchenbachSJ, LuthraHS. Idiopathic retroperitoneal fibrosis: a retrospective review of clinical presentation, treatment, and outcomes. Mayo Clin Proc. 2011;86(4):297-303. doi:10.4065/mcp.2010.0663Suche in Google Scholar PubMed PubMed Central
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Artikel in diesem Heft
- EDITORIAL
- 10.7556/jaoa.2017.049
- LETTERS TO THE EDITOR
- Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy
- RESPONSE
- Response
- CORRECTION
- Correction
- AOA COMMUNICATION
- Official Call: 2017 Annual Business Meeting of the American Osteopathic Association
- ORIGINAL CONTRIBUTION
- Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
- EVIDENCE-BASED CLINICAL REVIEW
- Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
- CLINICAL PRACTICE
- An Osteopathic Approach to Chronic Pain Management
- MEDICAL EDUCATION
- Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
- SPECIAL COMMUNICATION
- Introducing High School Students to Careers in Osteopathic Medicine
- THE SOMATIC CONNECTION
- Cardiorespiratory Benefit of Aerobic Exercise for Patients With Asthma
- Cost-Effective Management of Low Back and Joint Pain by Specialty
- Benefit of OMT in Patients Who Underwent Heart Surgery
- Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
- Effectiveness of OMT and OCMM for Temporomandibular Disorders
- Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
- The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
- CLINICAL IMAGES
- Pacemaker Twiddler Syndrome
- Retroperitoneal Fibrosis
