A 70 year old gentleman diagnosed with metastatic squamous cell carcinoma

A 70 year old gentleman diagnosed with metastatic squamous cell carcinoma

  • A 70-year-old gentleman was diagnosed with metastatic squamous cell carcinoma (metastases to left adrenal gland) in February 2017; completed chemotherapy (Paclitaxel + Carboplatin) on May 2017. No radiotherapy.
  •  The disease was stable on the last follow-up scan (April 2021).
  1. Atherosclerotic changes in the abdominal aorta. No periaortic soft tissue
  2. Significant non-enhancing peri-aortic soft tissue thickening and fat stranding seen adjacent the infrarenal aorta extending upto aortic bifurcation and abutting the inferior vena cava laterally with no significant luminal narrowing or thrombosis.




  • Retroperitoneal fibrosis (RPF) encompasses a range of diseases characterized by proliferation of aberrant fibroinflammatory tissue, which usually surrounds the infrarenal portion of the abdominal aorta, inferior vena cava, and iliac vessels. 
  • Risk factors include asbestos exposure, smoking, tumor, infection, trauma, radiotherapy, surgery, and use of certain drugs.
  • The idiopathic form of RPF accounts for more than two-thirds of cases; the rest are secondary to factors such as drug use, malignancies, or infections. If promptly diagnosed and treated, idiopathic and most other benign forms of RPF have a good prognosis. 
  • In contrast, malignant RPF, which accounts for up to 10% of cases, has a poor prognosis. 
  • In early or active stages, variable enhancement can be seen with intravenous contrast while no enhancement may be seen in quiescent disease.
  • Therefore, the most important diagnostic challenge is differentiation of benign from malignant RPF. 
  • The patient underwent a CT guided biopsy of the retroperitoneal periaortic soft tissue using coaxial needle system.
  • The differentials considered were idiopathic retroperitoneal fibrosis and malignant RPF.
  • Biopsy of periaortic soft tissue revealed features consistent with retroperitoneal fibrosis. Negative for malignancy.
  • IHC confirmed IgG4 related retroperitoneal fibrosis.


  • https://rarediseases.info.nih.gov/diseases/9568/retroperitoneal-fibrosis
  • Caiafa RO, Vinuesa AS, Izquierdo RS, Brufau BP, Ayuso Colella JR, Molina CN. Retroperitoneal fibrosis: role of imaging in diagnosis and follow-up. Radiographics. 2013 Mar;33(2):535-52.
  • Ranschaert, E., Bell, D. Retroperitoneal fibrosis. Reference article, Radiopaedia.org. (accessed on 13 Jan 2022) https://doi.org/10.53347/rID-14537

Dr Rajesh V Helavar
Consultant Interventional and Diagnostic Radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru

Dr Vikas H P
Radiology Resident
Manipal Hospital, Yeshwanthpur, Bengaluru