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AJR Am J Roentgenol. 199(1):11826, 2012 Li KP et al: Idiopathic retroperitoneal fibrosis (RPF): clinical features of 61 cases and literature review. Clin Rheumatol. 30(5):601-5, 2011 Cronin CG et al: Retroperitoneal fibrosis: a review of clinical features and imaging findings. AJR Am J Roentgenol. 191(2):423-31, 2008 Vaglio A et al: Retroperitoneal fibrosis. Lancet. 367(9506):241-51, 2006 Fukukura Y et al: Autoimmune pancreatitis associated with idiopathic retroperitoneal fibrosis. AJR Am J Roentgenol.

Spread to lymph nodes or hematogenous spread through the renal vein and inferior vena cava may occur and constitute important elements of the imaging and staging of this tumor. Anterior Pararenal Space Disease within the anterior pararenal space is common. For example, acute pancreatitis results in peripancreatic infiltration ± fluid collections that spread throughout the anterior pararenal space, often affecting the duodenum and ascending and descending colon segments that share this anatomic compartment.

Left) Axial CECT in the same patient reveals bilateral hydronephrosis ﬇ due to the fibrotic soft tissue mass shown in the previous image. (Right) Axial CECT in the same patient shows atypical, caudal extension of the fibrotic process ﬈ into the pelvis along the iliac vessels. 23 Retroperitoneum Pelvic Lipomatosis KEY FACTS TERMINOLOGY • Uncommon progressive benign overgrowth of mature, unencapsulated fat in perirectal and perivesical spaces IMAGING • Symmetrically distributed, nonencapsulated fat surrounding pelvic organs ○ No soft tissue component or enhancement of fat • Superior displacement of bladder, prostate, seminal vesicles, sigmoid colon • Inverted pear- or teardrop-shaped bladder ○ Dilated, medially displaced ureters • Elongated, narrowed rectum due to smooth, concentric extrinsic compression ○ Elongated, straight, narrowed rectosigmoid colon TOP DIFFERENTIAL DIAGNOSES • Normal variant ○ Large pelvic muscles with narrow bony pelvis (Left) Axial CECT shows the inverted pear- or teardropshaped appearance of the bladder st.

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