A 60-year-old man presents with dull flank pain, raised erythrocyte sedimentation rate and progressive renal impairment. Contrast CT shows smooth bilateral hydronephrosis with medial deviation and tapering of the mid-ureters, and a soft tissue mass encasing the aorta. What is the most likely diagnosis?

• A Retroperitoneal fibrosis (Ormond disease) ✓
• B Bilateral ureteric tuberculosis
• C Retroperitoneal lymphoma
• D Bilateral PUJ obstruction

Explanation

Idiopathic retroperitoneal fibrosis presents in older men with flank pain, raised inflammatory markers and renal failure from extrinsic compression of the ureters. The characteristic CT finding is a confluent soft tissue plaque encasing the aorta and IVC with medial deviation of the mid-ureters, unlike lateral displacement caused by retroperitoneal masses such as lymphoma. Management is steroid therapy with ureterolysis if needed. Tuberculosis produces strictures and calcification rather than a smooth encasing plaque, and PUJ obstruction does not cause ureteric encasement.

Reference: Campbell-Walsh Urology, 12th ed.

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