Case 89: Biopsy of Retroperitoneal Fibrosis

This 64-years old presented with backache and fever. CT and then subsequently PET/CT showed findings typical of retroperitoneal fibrosis.

The oncologist and rheumatologist wanted a biopsy, to prove the diagnosis and to look for tissue IgG4.

Would you do the biopsy? If so, would it be a supine anterior or prone posterior approach?

To see what I did and to learn more about biopsies of retroperitoneal lesions and retroperitoneal fibrosis in particular, please see the video.

Region: Retroperitoneum
Age: 64
Findings: Retroperitoneal soft tissue encasing vessels
Lesion Biopsied: Left para-aortic soft tissue
Size of Lesion: Not relevant
Gun: 20 G, 10 mm throw
No of cores: 3 for histopath
Sedation: No
Position & Approach: Prone, intravenous contrast
Time Taken (marker to wash-out): 8 mins
Complication: None
Level of Difficulty: 5/5
Diagnosis: Retroperitoneal fibrosis, perhaps IgG4

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