Abstract: PUB056
Incidental Finding of Retroperitoneal Lipomatosis
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Tillquist, Kristen N., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Al Haddad, Nadia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Reisinger, Nathaniel, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Introduction
Knowledge of imaging findings is key to the appropriate diagnosis and treatment of AKI. Here we present a rare incidental finding.
Case Description
A 70-year-old man with hypertension and diabetes presented with complaints of abdominal pain found to be in septic shock due to ascending cholangitis with mixed bacteremia. He was treated with fluids, antibiotics, and percutaneous cholecystostomy with course complicated by acute dyspnea due to pulmonary edema and pulseless cardiac arrest further complicated by AKI for which we were consulted. Exam revealed increased work of breathing and abdominal distention. Urine sediment examination revealed pigmented granular casts. Serum creatinine was 3.33 mg/dL rising from a baseline of 1.03. Echocardiography revealed severe biventricular failure. Right heart catheterization showed right atrial pressure of 8 mmHg with pulmonary capillary wedge pressure of 8 mmHg. Imaging findings in caption.
Discussion
Retroperitoneal liposmatosis is a rare diagnosis consisting of symmetric lipomatous hyperplasia of perinephric adipose tissue. Presentation is usually asymptomatic and incidental, found on imaging obtained for other indications as in our case. Pathology has been described with symptomatic abdominal distention and rarely urinary obstruction. On CT, this appears as marbling of hypoattenuating and hyperattenuating tissue in the retroperitoneal space surrounding the kidneys. On ultrasound, this entity appears as hyperechoic tissue in the hepatorenal and splenorenal recess which can easily be mistaken for hemorrhage. We also considered retroperitoneal fibrosis leading to obstruction without hydronephrosis, but the CT showed fat characteristics that did not affect the collecting system area and urine sediment findings were consistent with ATN.
Left: coronal CT with retroperitoneal lipomatosis (arrow), aortic aneurysm (star)
Right top: transverese CT with retroperitoneal lipomatosis (arrow)
Right lower: sagittal ultrasound with retroperitoneal lipomatosis (arrow), liver subcapsular hematoma (arrowhead)