warfarin and Retroperitoneal-Fibrosis

A 53-year-old female was hospitalized for evaluation of swelling in the bilateral lower extremities. A computed tomography (CT) scan of the abdomen revealed bilateral hydronephrosis and features consistent with retroperitoneal fibrosis. Transfemoral venography and magnetic resonance angiography (MRA) showed thrombosis of both the left common iliac vein and inferior vena cava, and filling of numerous collateral veins in the retroperitoneal area. A diagnosis of idiopathic retroperitoneal fibrosis with central venous thrombosis was made. Ureteral stenting, medication with corticosteroids and subsequent warfarin were started, resulting in marked improvement of renal function and the lower extremities. Diagnosis and follow-up of deep venous thrombosis can be aided by MRA. Administration of steroids with anticoagulation was considered to be successful in the case presenting with deep venous thrombosis caused by retroperitoneal fibrosis.

Topics: Anticoagulants; Female; Fibrinolytic Agents; Humans; Iliac Vein; Magnetic Resonance Angiography; Middle Aged; Prednisolone; Retroperitoneal Fibrosis; Tomography, X-Ray Computed; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Idiopathic retroperitoneal fibrosis is exceedingly uncommon in childhood and its etiology is uncertain. Support for an immunological basis for the disease is given by a report of a 14-year-old girl with severe retroperitoneal fibrosis causing progressive azotemia in whom azathioprine and prednisolone were used successfully. This case supports the efficacy of immunotherapy in the treatment of idiopathic retroperitoneal fibrosis.

Topics: Adolescent; Azathioprine; Biopsy; Drug Therapy, Combination; Female; Humans; Immunosuppression Therapy; Kidney; Prednisolone; Retroperitoneal Fibrosis; Retroperitoneal Space; Time Factors; Tomography, X-Ray Computed; Ultrasonography; Warfarin