Retroperitoneum

Question 1

Where is the retroperitoneum space?

Answer 1

-Posterior to peritoneal
-Anterior to transversalis fascia

(extends from diaphragm to pelvic brim)

Question 2

What does the retroperitoneum include?

Answer 2

-Diaphragmatic crura (tendon)
-Pancreas
-Distal CBD
-Duodenum
-Kidneys
-Adrenals
-AO/IVC
-SMA/SMV
-SA/SV
-HA
-Lymph vessels + nodes

Question 3

Is u/s the gold standard?

Answer 3

No, CT is

Question 4

What are the 3 spaces of the retroperitoneal?

Answer 4

-Anterior pararenal
-Perirenal/perinephric
-Posterior pararenal

Question 5

Where is the anterior renal/gerota fascia?

Answer 5

Anterior to great vessels, kidneys + adrenals

Question 6

Where is the posterior renal/zuckerkland fascia?

Answer 6

-Fuses with anterior laterally
-Posterior to kidney

Question 7

How are fascial planes fused/unfused?

Answer 7

Fused: superiorly
Unfused: inferiorly

Question 8

What does the anterior pararenal space include?

Answer 8

-Pancreas
-Distal CBD
-Duodenum
-Colon
-Fat

Question 9

What does the perirenal/perinephric space include?

Answer 9

-Kidneys
-Adrenals
-Vessels (AO + IVC)
-Fat

Question 10

What does the posterior pararenal space include?

Answer 10

-Only fat (no organs)

Question 11

What is diaphragmatic crura?

Answer 11

Tendinous fibers that blend in with the anterior longitudinal ligament of the veretrbal column

Question 12

Which crus is longer?

Answer 12

Right (also more lobular)

Question 13

What are the functions of the lymphatic system?

Answer 13

-Collects plasma fluid that oozes
-Collects cellular debris + bacteria
-Absorbs + transports dietary fat

Question 14

What is chyle cistern?

Answer 14

-Collecting area in mid-retroperitoneum
-Collects lymph from lower extremities + pelvis before ascending to thoracic duct

Question 15

Where are parietal nodes found?

Answer 15

Surrounds great vessels
(in retroperitoneum)

Question 16

Where are visceral nodes found?

Answer 16

Found at the hilum of organs
(in peritoneal)

Question 17

Where are lacteal nodes found?

Answer 17

-Along small + mesentery
-Absorbs dietary fat

Question 18

Are normal retroperitoneal lymph nodes seen on u/s?

Answer 18

No, only if abnormally enlarged

Question 19

Are normal superficial lymph nodes seen on u/s?

Answer 19

Yes

Question 20

What do normal lymph nodes look like?

Answer 20

-Oval/almond shaped
-Echogenic central fatty hilum

(if not, then indicates malignancy)

Question 21

Which space m/c has the most amount of fat?

Answer 21

Perirenal space

(think b/c it can help identify the kidneys)

Question 22

Are perirenal fascia planes always visible?

Answer 22

No

Question 23

What does diaphragmatic crura look like?

Answer 23

-Hypoechoic structure
-Surrounded by hyperechoic tissue

Question 24

What does the quadratus lumborum + psoas muscles look like?

Answer 24

-Hypoechoic structures
-Echogenic linear fibers running along the length of it

Question 25

What is the m/c site for a fluid collection?

Answer 25

Anterior pararenal space (b/c appendix, duodenum, colon + panc are close by)

Question 26

What does the echogenicity of blood look like with hematomas?

Answer 26

-Acute anechoic -Echogenic when clots -Hyperechoic as it ages

Question 27

What is the m/c cause of a lymphocele?

Answer 27

Iatrogenic from medical procedure

Question 28

When will a lymphocele develop?

Answer 28

10-21 days after surgery or up to 8 weeks after transplant

Question 29

What is the m/c cause of a urinoma?

Answer 29

Obstruction (LABS: hematuria)

Question 30

Lightbulb for an abscess?

Answer 30

Increased WBC's

Question 31

What is retroperitoneal fibrosis?

Answer 31

Chronic inflammation where tissue grows + surrounds the great vessels, ureters + lymphatics (located in perinephric space or around ureters)

Question 32

What is the m/c cause of RP fibrosis?

Answer 32

Idiopathic

Question 33

What gender is RP fibrosis m/c in?

Answer 33

Men

Question 34

What do solid neoplasms usually involve?

Answer 34

Lymph nodes

Question 35

Lightbulb for lymphadenopathy?

Answer 35

Common in patiens with HIV/AIDS

Question 36

What indicates malignancy with enlarged lymph nodes?

Answer 36

-No fatty hilum* -Round shape* -Avascular areas -Asymmetric cortical widening

Question 37

What is lymphadenitis?

Answer 37

-Enlarged, inflamed lymph nodes -Has fatty hilum -Has normal oval/almond shape

Question 38

Are primary neoplasms common?

Answer 38

Nope, m/c are metastases

Question 39

What is the m/c malignant neoplasm of the RP?

Answer 39

Liposarcoma

Question 40

What is the 2nd m/c malignant neoplasm of the RP?

Answer 40

Leiomyosarcoma

Question 41

Characteristics of liposarcomas?

Answer 41

-M/c men -M/c malignant neoplasm -Very large -Poorly defined -Anterior to spine + psoas muscles -Anemia

Question 42

Characteristics of leiomyosarcomas?

Answer 42

-M/c women -2nd m/c malignant neoplasm -Has gas, necrosis + hemorrhage -Well defined