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Retroperitoneal fibrosis: a case report of spontaneous resolution
1Division of Urology, St Joseph's Health Care, London, Ontario, Canada.
Aim:
The purpose of this case report is to document an occurrence of spontaneous resolution of idiopathic retroperitoneal fibrosis and to review the investigation and management of this unusual condition.
Materials And Methods:
A detailed case summary of a patient with retroperitoneal fibrosis is presented. Current citations in Index medicus from the English-speaking literature of relevance to the topic were reviewed.
Conclusions:
In this patient who refused open surgical intervention, bilateral stent placement allowed stabilization of renal function. CT-guided biopsy did not reveal malignancy. Serial CT imaging demonstrated gradual disappearance of the retroperitoneal mass. From the literature review, spontaneous resolution of this condition appears to be a rare phenomenon. Although often utilized, CT-guided biopsy may fail to exclude the presence of malignancy. Open surgical biopsy of the retroperitoneal mass and ureterolysis remain the standard of care for operative candidates. Establishing renal drainage and considering a trial of steroids or surveillance may be an option in carefully selected individuals.
Insights
Idiopathic retroperitoneal fibrosis can spontaneously resolve, as seen in a patient who refused surgery. Bilateral stent placement stabilized renal function, and imaging showed the mass disappearing over time.
Area of Science:
- Nephrology
- Urology
- Radiology
Background:
- Idiopathic retroperitoneal fibrosis is a rare condition characterized by inflammatory tissue surrounding the retroperitoneum.
- Diagnosis and management can be challenging due to its varied presentation and potential complications.
Observation:
- A case of idiopathic retroperitoneal fibrosis is presented where the patient declined open surgical intervention.
- Bilateral ureteral stent placement was performed to stabilize renal function.
- Computed tomography (CT)-guided biopsy did not identify malignancy.
Findings:
- Serial CT imaging revealed a gradual and spontaneous disappearance of the retroperitoneal mass.
- Literature review indicates spontaneous resolution of retroperitoneal fibrosis is uncommon.
- CT-guided biopsy may not definitively rule out malignancy.
Implications:
- While open surgical biopsy and ureterolysis are standard for surgical candidates, this case suggests alternative management may be possible.
- Renal drainage, conservative management with steroids, or surveillance could be considered in select patients.
- This case highlights the possibility of spontaneous resolution and the limitations of CT-guided biopsy in excluding malignancy.