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GENITOURINARY TRACT IMAGING Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 2  |  Page : 251-252
Bilateral idiopathic replacement lipomatosis of the kidney with posterior mediastinal lipomatosis


Department of Radiodiagnosis and Imaging, JJM Medical College, Dagangree-577004, Karnataka, India

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Keywords: Renal sinus, Lipomatosis

How to cite this article:
Setty N, Uma K, Narvekar V N, Desai R S. Bilateral idiopathic replacement lipomatosis of the kidney with posterior mediastinal lipomatosis. Indian J Radiol Imaging 2002;12:251-2

How to cite this URL:
Setty N, Uma K, Narvekar V N, Desai R S. Bilateral idiopathic replacement lipomatosis of the kidney with posterior mediastinal lipomatosis. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Nov 19];12:251-2. Available from: http://www.ijri.org/text.asp?2002/12/2/251/28457
Renal sinus lipomatosis, replacement lipomatosis and fibrolipomatosis are used interchangeably to denote a condition of varying severity in which

normal renal sinus and perirenal fat increases in amount and replaces the renal parenchyma [1]. Actually these terms represent a spectrum of changes where renal sinus lipomatosis is the mildest and most common form and replacement lipomatosis is the extreme form.

Renal sinus lipomatosis usually occurs in the sixth or the seventh decade as normal renal parenchyma atrophies (senile atrophy). This is of no clinical significance. It is also seen in obesity and atherosclerosis.

At the other end of the spectrum are a few patients in whom the renal parenchyma has been almost entirely destroyed, usually secondary to calculous disease and chronic pyelonephritis. The destroyed renal parenchyma is replaced by fat i.e, replacement lipomatosis [2]. Usually it is unilateral in occurrence. Other causes of replacement lipomatosis include renal tuberculosis and renal infarction where the lipomatosis is usually focal and rarely idiopathic [3]. Of all the causes mentioned above, except in the case of obesity, the increase in fat is associated with a loss of renal parenchyma [4].

We wish to present an atypical case of bilateral renal sinus, renal hilar and perinephric lipomatosis associated with posterior mediastinal lipomatosis.

An 18 year old man came with complaints of mild pain in both the loins and chest since past six years. The patient was not obese. There was no history of surgery or long term medication. Blood urea and serum creatinine were within normal limits.

US abdomen revealed an increase in the renal sinus fat bilaterally. The renal contour was maintained. There was no calculus or hydronephrosis. The left kidney was enlarged in size due to a duplex collecting system. An IVU examination [Figure - 1] showed prompt and equal excretion of contrast by both kidneys with markedly splayed and elongated calyces. There were multiple radiolucencies in the renal sinus regions suggestive of fat. A CT scan confirmed the fatty infiltration, which was present in the sinus region, hilum, perinephric space [Figure - 2] and in the posterior mediastinum from T-5 to T-11 [Figure - 3]. The lipomatosis was more in the left kidney. The cortical enhancement was normal, but the thickness was decreased uniformly. There were no features of pelvic lipomatosis

As the renal function was good and prompt, a post inflammatory cause of the renal atrophy was rule out. As the patient was a normotensive individual, atherosclerosis was also ruled out. There was no evidence of calculous disease either. Renal TB is usually present in the second to the fourth decade with macroscopic progression of the disease being almost always unilateral [5]. Our patient did not show any clinical or radiological features of genitourinary TB. Therefore by exclusion, a probable idiopathic cause of bilateral replacement lipomatosis of the kidney was considered.

Extensive review of the literatures did not reveal any occurrence of replacement lipomatosis of the kidney in the second decade or bilateral presentation or association with posterior mediastinal lipomatosis.

 
   References Top

1.Faegenburg D, Bosnaik MA, Evans JA. Renal Sinus Lipomatosis: its demonstration by nephrotomography. Radiology 1964; 83:987-997  Back to cited text no. 1    
2.Karasick S, Wechsler RJ. Case report. Replacement lipomatosis of the kidney. Radiology 2000; 215:754-756.  Back to cited text no. 2    
3.Poilly JN, Dickie J, James WB. Renal Sinus lipomatosis: a report of 26 cases. Br J Urol 1969; 141;257-266.  Back to cited text no. 3    
4.Ambos MA, Bosnaik MA, Grodon R, Madayag MA. Replacement lipomatosis of the kidney. Am J Roentgenol 1978; 130:1087-1091.  Back to cited text no. 4    
5.Merchant SA. Tuberculosis of the genitourinary system. Ind J Radiology Imaging 1993; 3:253-274  Back to cited text no. 5    

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Correspondence Address:
NHA Setty
Department of Radiodiagnosis and Imaging, JJM Medical College, Dagangree-577004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Idiopathic renal replacement lipomatosis: A case report and review of literature
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Indian Journal of Pathology and Microbiology. 2009; 52(4): 552-553
[Pubmed]



 

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