Practical approach to primary retroperitoneal masses in adults

Primary retroperitoneal masses constitute a heterogeneous group of uncommon lesions and represent a challenge due to overlapping imaging findings. Most are malignant lesions. Although they are more prevalent in adults, they can occur at any age. Such lesions are classified as primary when they do not originate from a specific retroperitoneal organ and are divided, according to the image findings, into two major groups: solid and cystic. The clinical findings are nonspecific and vary depending on the location of the lesion in relation to adjacent structures, as well as on its behavior. The main imaging methods used for staging and surgical planning, as well as for selecting the biopsy site and guiding the biopsy procedure, are computed tomography and magnetic resonance imaging. In most cases, the treatment is challenging, because of the size of the lesions, vascular involvement, or involvement of adjacent organs. In this article, we present a review of the retroperitoneal anatomy and a practical approach to the main imaging features to be evaluated, with a view to the differential diagnosis, which can guide the clinical management.