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Differential Diagnosis of Retroperitoneal and Intraperitoneal Lesions

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So what are retroperitoneal lesions

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and how do they appear?

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They may appear as cystic Foci,

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which may be non-neoplastic or neoplastic

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and nature those that are neoplastic could

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be primary malignancies or metastases in

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similar fashion. We have solid retroperitoneal lesions

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that may be neoplastic or

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non neoplastic a nation and in similar

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fashion those that are neoplastic could be primary or

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secondary in nature.

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So when it comes to statistic lesions of the Retro peritoneum, so

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the cystic RP masses are relatively uncommon and

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they're actually less likely than solid lesions

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to be neoplastic in nature.

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So when we think about examples of these neoplasms in the

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retroperitoneal anatomic compartment, we're thinking

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about teratomas mucinous asadenomas. And

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when we think of the non neoplastic examples, these would

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be the malarian cysts pancreatic pseudosis post

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pancreatitis collections, uranomas hematomas,

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and of course hepodomoysis.

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When we think about solid lesions, we're thinking about again

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the neoplastic and non-neoplastic regions.

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So when we think about solid lesions of the ratchet, peritoneum

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These are more likely than cystic lesions

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to be neoplastic.

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So the neoplastic examples that we think about are going to be sarcomas. They're

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going to be the neurogenic tumors just the paragangliomas.

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You're gonna be the germ cell tumors immature teratomas

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is in this category as well.

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Of course, there's Mets and Lymphoma.

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Here we see to the right in the CT image. We see a suspected

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or RP sarcoma. Just north of the

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right, kidney.

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When we think about the non-neoplasty examples, we're thinking about

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retropertial fibrosis extra medullary

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amount of pieces things like castleman's disease

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and gesture disease.

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So what about the cystic lesions of the omentum the

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messenger in the peritoneum?

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So cystic lesions within the momentum the mesentery in

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the peritoneum actually carry a lesser recip malignancy and solid

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lesions. So in terms of non neoplast examples these

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include duplication cysts lymphocyles lymphangiomas

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and pancreatic pseudosis. When

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we think about the neoplastic examples, we're thinking what's

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cystic mesothelioma cystic spindle cell tumors,

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of course my sarcoma being one of them and

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stick teratomas.

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So we've established that some lesions of

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the insurance abdominal connective tissues have a higher likelihood of

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neoplasm, but it's important to distinguish whether these are

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primary which are particularly rare or secondary lesions,

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which can occur secondary to metastasis or direct

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Invasion from other malignancies Regional to

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that location.

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So these neoplastic examples include the GI stromal

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tumors the commonly referred to as just the

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carcinoid tumors lymphoma liposarcomas

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and Des Moines tumors.

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When we think about the non-neoplasty examples, this includes

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the wispy sclerosing mesenteritis lymphatinopathy

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that could occur in the setting of

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infection or inflammation.

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So in some areas of the world, which of the following is

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the most common source of peritoneal implants.

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berylliosis tuberculosis silicosis

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or aspergillosis

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if you considered tuberculosis, then you would be correct.

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We'll peritoneal implants secondary to mycobacterium tuberculosis

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that are actually common infectious causes

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of peritoneal implants in some regions of the world particularly retuberculosis

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remains endemic and here we see a thickening

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of the peritoneal lining with some nodules or

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implants rather in this image

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and the right

Report

Faculty

Mikhail CSS Higgins, MD, MPH

Director, Radiology Medical Student Clerkships; Director, ESIR

Boston University Medical Center

Tags

Retroperitoneum

Peritoneum/Mesentery

Oncologic Imaging

Non-infectious Inflammatory

Neoplastic

MRI

Interventional

Infectious

Genitourinary (GU)

Gastrointestinal (GI)

Congenital

CT

Body

Acquired/Developmental