Displaced Plaque in Retroperitoneal Adenopathy
Displaced Plaque in Retroperitoneal Adenopathy
Background: This study was designed to determine when to consider incidental retroperitoneal masses on the basis of a displaced calcified atheromatous abdominal aorta on lateral radiographs.
Methods: We did a retrospective review of 143 normal abdominal helical computed tomography scans of individuals aged 50 years and older to measure the distance between the posterior aortic wall and anterior cortex of vertebral bodies from T12 through L3.
Results: The normal abdominal aorta maintains a close relationship to the vertebral column. The distance should not be more than 10 mm in men and 7.3 mm in women.
Conclusion: Displacement of aortic calcified atheroma greater than these distances should prompt a search for a retroperitoneal mass.
Clinical diagnosis of a retroperitoneal lesion is difficult. Although modern diagnostic techniques such as computed tomography (CT) permit accurate assessment of the retroperitoneum, many patients with retroperitoneal disease present with nonspecific symptoms, including abdominal and back pain, and often have abdominal and spinal radiographs for workup rather than a cross-sectional study. We recently encountered a patient in whom initial workup for low back pain included a lateral lumbar radiograph that showed a calcified atheromatous abdominal aorta displaced anteriorly (Fig 1). Both CT (Fig 2) and ultrasonography (Fig 3) revealed retroperitoneal lymph node enlargement. This case prompted our study to establish the normal location of the abdominal aorta in relation to the vertebral column and its implication on diagnosis of retroperitoneal disease.
(Enlarge Image)
Anteriorly displaced calcified aortic plaque on lateral radiograph of lumbar spine in 70-year-old woman with lymphoma.
(Enlarge Image)
Computed tomography of same patient shows aorta anteriorly displaced by retroperitoneal mass.
(Enlarge Image)
Ultrasonograms confirmed computed tomography findings (Fig 2).
Background: This study was designed to determine when to consider incidental retroperitoneal masses on the basis of a displaced calcified atheromatous abdominal aorta on lateral radiographs.
Methods: We did a retrospective review of 143 normal abdominal helical computed tomography scans of individuals aged 50 years and older to measure the distance between the posterior aortic wall and anterior cortex of vertebral bodies from T12 through L3.
Results: The normal abdominal aorta maintains a close relationship to the vertebral column. The distance should not be more than 10 mm in men and 7.3 mm in women.
Conclusion: Displacement of aortic calcified atheroma greater than these distances should prompt a search for a retroperitoneal mass.
Clinical diagnosis of a retroperitoneal lesion is difficult. Although modern diagnostic techniques such as computed tomography (CT) permit accurate assessment of the retroperitoneum, many patients with retroperitoneal disease present with nonspecific symptoms, including abdominal and back pain, and often have abdominal and spinal radiographs for workup rather than a cross-sectional study. We recently encountered a patient in whom initial workup for low back pain included a lateral lumbar radiograph that showed a calcified atheromatous abdominal aorta displaced anteriorly (Fig 1). Both CT (Fig 2) and ultrasonography (Fig 3) revealed retroperitoneal lymph node enlargement. This case prompted our study to establish the normal location of the abdominal aorta in relation to the vertebral column and its implication on diagnosis of retroperitoneal disease.
(Enlarge Image)
Anteriorly displaced calcified aortic plaque on lateral radiograph of lumbar spine in 70-year-old woman with lymphoma.
(Enlarge Image)
Computed tomography of same patient shows aorta anteriorly displaced by retroperitoneal mass.
(Enlarge Image)
Ultrasonograms confirmed computed tomography findings (Fig 2).
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