Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know
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REVIEW
Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know Ferenc Czeyda‑Pommersheim1 · Christine Menias2 · Annemarie Boustani1 · Margarita Revzin1 Received: 26 May 2020 / Revised: 30 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Retroperitoneal soft tissue lesions represent a wide range of disease processes with overlapping imaging findings. Familiarity with the CT and MR characteristics of these conditions is important to guide clinical evaluation. We review the tissue types, characteristic clinical, demographic, and imaging features of retroperitoneal tumors and tumor-like non-neoplastic conditions with CT and MR correlation, including anatomic and imaging clues, and provide a diagnostic approach to aide the radiologist in making a specific diagnosis. Keywords Retroperitoneum · Mesenchymal tumors · Neurogenic tumors · Amyloidosis · Erdheim–Chester disease · Arteriovenous malformation
Introduction A wide range of benign and malignant pathologies arise from the retroperitoneal spaces of the abdomen and pelvis. In general, a mass or process is considered to be primary to the retroperitoneum if it originates from the soft tissues, lymphatics or neural tissue of the retroperitoneum and not from its solid organs. This heterogeneous group of diseases often poses a diagnostic challenge for radiologists. Two Main categories of primary retroperitoneal pathologies are recognized: neoplastic and non-Neoplastic. The majority of primary retroperitoneal neoplasms are malignant (Table 1) [1–4]. Although a definitive diagnosis often cannot be established on imaging, the primary role of the radiologist is to determine whether a biopsy is necessary and/or if the mass is resectable.
Primary retroperitoneal non-neoplastic pathologies include Castleman disease, extramedullary erythropoiesis Erdheim–Chester disease and amyloidosis many of which demonstrate characteristic imaging findings that are important to recognize in order to avoid unnecessary biopsy or surgery (Table 2). In this article, we review neoplastic and non-neoplastic primary retroperitoneal conditions, their relevant pathophysiology, clinical presentation, and characteristic CT and MRI imaging findings, particularly key features that can aid in establishing an accurate diagnosis and guide therapy. Additionally, we will provide a comprehensive diagnostic approach for the differentiation of neoplastic from non-neoplastic pathologies that can serve as a road map for narrowing the differential diagnosis and allow for appropriate and timely management.
Anatomy of the retroperitoneum at a glance Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02752-8) contains supplementary material, which is available to authorized users. * Ferenc Czeyda‑Pommersheim Ferenc.Czeyda‑[email protected] 1
Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042
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