Ultrasound Registry Review (URR) Abdomen Practice Exam

Where does retroperitoneal fibrosis most commonly occur?

Occurs around the renal cortex Occurs near the diaphragm Occurs around the porta hepatis Most commonly occurs at the level of the AO bifurcation and inferiorly in the pelvis

Correct Answer:

Most commonly occurs at the level of the AO bifurcation and inferiorly in the pelvis

Explanation:

Retroperitoneal fibrosis tends to form fibrous tissue in the infrarenal retroperitoneum, around the abdominal aorta and iliac vessels, typically at and below the level of the aortic bifurcation and extending into the pelvis. This pattern is because the lower retroperitoneum is where inflammatory or fibrotic processes commonly encase structures like the ureters and major vessels, leading to the characteristic periaortic/pelvic rind seen on imaging. Involvement around the renal cortex would be intrarenal, and involvement near the diaphragm or porta hepatis would be suprarenal or prehepatic, not the typical infrarenal retroperitoneal distribution. Therefore, the most common location is at the level of the aortic bifurcation extending into the pelvis.

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