8. Iliopsoas compartment
- located within and immediate adjacent to
psoas muscle
- posteromedial to the posterior pararenal
space
9.
10.
11. The retromesenteric, retrorenal, and lateroconal
planes are potential routes of interfascial
communication between the retroperitoneal
spaces. Retroperitoneal hemorrhage or rapidly
expanding fluid collections can spread via
these interfascial connections.
12. Largest
Pancreas, Duodenum, Colon
Continuous across the midline
13.
14. Smallest
Continues anterolaterally into the
properitoneal fat, the extraperitoneal fat of the
anterior abdominal wall.
30. Multidetector CT in retroperitoneal
haemorrhages, fluid collections, AAA and
masses.
Magnetic resonance (MR) imaging has an
increasing role in evaluating soft-tissue masses
of the extraperitoneal spaces.
31. Below the kidneys, the retroperitoneal spaces -a single
space with direct contiguity between the anterior and
posterior portions.
Retroperitoneal hemorrhage or fluid spread from the
abdominal retroperitoneum into the extraperitoneal
pelvis along the anterior and posterior perirenal
fasciae, which combine to form the fascial plane in the
iliac fossa .
Superiorly, the perirenal fasciae are attached to the
diaphragm.
On the right side, the bare area of the liver is directly
connected to the anterior pararenal space.
Therefore, hepatic lacerations involving the bare area
of the liver can be a source (albeit uncommon) of
retroperitoneal hemorrhage.
32. CT findings of duodenal injury
- duodenal wall thickening
- periduodenal fluid
- Fluid in the right anterior pararenal space
- Diminished bowel wall enhancement of the
injured segment
- extraluminal air (More specific sign of duodenal
perforation)
- extraluminal oral contrast material air (More
specific sign of duodenal perforation)
- the “sentinel clot” sign
33.
34.
35.
36. Two-thirds of blunt pancreatic injuries occur in
the pancreatic body, with the remainder
occurring with equal frequency in the
head, neck, and tail.
37.
38.
39.
40.
41. Goals of imaging
- to identify the retroperitoneal hemorrhage, its
location and its possible source
- to assess its relative stability on the basis of the
size and presence (or absence) of active
extravasation of intravascular contrast material
42. Surgical standpoint, the retroperitoneum can be
divided into zones because hematoma location
has therapeutic implications
43.
44.
45.
46. Pelvic retroperitoneum is the most common
location of retroperitoneal
hemorrhage, frequently in association with
pelvic fractures.
47. In the setting of trauma should raise suspicion
for
- Pancreatic injury
- Duodenal injury
- Renal collecting system injury (with urine
leakage)
- Retroperitoneal hemorrhage
48. Primary
- Lymphoid malignancy : NHL, HL, HIV related
NHL
- Enlarged LNs in HIV
- Soft tissue masses
Secondary
- Lymphnodes Testicular, Prostate
- Metastases UB, Cervix etc..
49. Lymphnodes
1) Paracaval and paraortic : > 10 mm
2) Retrocural : > 7 mm
MRI has better distinction than CT between
LNs and vessels and bowels
50. NHL/HD
Paraortic LN very frequent in NHL as compared to
HD
Ann Arbor staging
51.
52.
53. Characterization of the Retroperitoneal Space
Displacement of retroperitoneal organs
strongly suggests that the tumor arises in the
retroperitoneum
Displacement of Major vessels and some of
their branches
54. Beak Sign: a mass deforms the edge of an adjacent
organ into a “beak” shape, it is likely that the mass
arises from that organ (beak sign)
55. Embedded Organ Sign.—When a tumor compresses an
adjacent plastic organ (eg, gastrointestinal tract, inferior
vena cava) that is not the organ of origin.
56. Phantom (Invisible) Organ Sign.—When a
large mass arises from a small organ, the organ
sometimes becomes undetectable.
Prominent Feeding Artery Sign.—
Hypervascular masses are often supplied by
feeding arteries that are prominent enough to
be visualized at CT or MR imaging, a finding
that provides an important key to
understanding the origin of the mass.
57. Although the MR imaging appearance of most
soft-tissue masses is nonspecific
The presence of certain histologic components
(eg, myxoid stroma, collagen
fibers, calcification, and fat) can be suggested
by evaluating intralesion signal intensity and
enhancement patterns.
Determination of the dominant histologic
component can help narrow the differential
diagnosis of the lesion.
However, management changes a bit
59. Target Sign: a central area of low to
intermediate signal intensity surrounded by a
ring of high signal intensity on T2-weighted
images
Corresponds to fibrous tissue centrally and
myxoid tissue peripherally and is commonly
seen in neurofibroma and schwannoma
61. Bowl of Fruit Sign: A mosaic of mixed
low, intermediate, and high signal intensity on
T2- weighted images as a result of admixture of
solid components, cystic
degeneration, hemorrhage, myxoid
stroma, and fibrous tissue.
This finding is commonly seen in malignant
fibrous histiocytoma, synovial sarcoma, and
Ewing sarcoma.
63. Proliferation of fibroblasts, infiltration of acute
inflammatory cells, and proliferation of
capillaries, surrounded by collagen fibers.
64. Eitiology
- Idiopathic (70 %) - Focal inflammatory or
- Around AAAs infectious conditions
- Medications e.g. - (e.g., diverticulosis, app
methysergide, beta endicitis, extravasation
blockers, methyldopa, h from the urinary tract).
ydralazine, antibiotics, a - Previous surgery or
nd some analgesics radiation treatment.
- systemic infections - Trauma.
(e.g., tuberculosis, syphi - Retroperitoneal
lis, actinomycosis, bruce hemorrhage.
llosis, fungal infections). - Marfan's disease.
- Inflammatow bowel
disease
65.
66.
67. Defined as focal area of dilatation of aortic
diameter >3 cm
Majority are infrarenal
2-20 %- juxtrarenal and pararenal
Atherosclerotic/ degenerative- most common
Other causes
68.
69. Inflammatory aneurysm (5-15 %)
Results from fibrotic autoimmune reaction to
atherosclerotic plaque
Difficult surgical management
70.
71. Infected aneurysms
More prone to rupture
Increased periaortic fat earliest sign
Irregularly shaped
