DOI:10.2214/AJR.05.51491
AJR 2005; 185:1368
© American Roentgen Ray Society
Reply
Satomi Kawamoto and
Elliot K. Fishman
Johns Hopkins Hospital Baltimore, MD 21287-0801
We greatly appreciate the interest in our article
[1] and the comments about the
images shown. The patient shown in Figure 3 of our article had multiple
ill-defined peripheral hypodense lesions in the bilateral kidneys in addition
to multiple cysts. The ill-defined peripheral hypodense lesions are similar to
the cases described in the letter by Dr. Brennan and Dr. Pedrosa. For our
patient shown in Figure 3, the renal lesions were interpreted as suspicious
for infiltrative process, but biopsy was not performed, and unfortunately the
pathologic diagnosis of the renal lesions was not made.
The patient in Figure 3 of our article had follow-up abdominal CT 3 months
later, and the peripheral hypodense renal lesions appeared less obvious than
on the initial CT. In this patient, there was also a left hilar mass extending
into the aortopulmonary window with bulky adenopathy in the mediastinum and
right hilum. Biopsy of the left hilar mass and mediastinal adenopathy under
mediastinoscopy and limited anterior thoracotomy revealed an anthracotic lymph
node with fibrosis and chronic inflammation, which was nonspecific and did not
indicate a specific cause for fibrosis. The histologic findings were not
diagnostic of sclerosing mediastinitis, but that entity could not be
excluded.
In a recent review of autoimmune pancreatitis, Sahani et al.
[2] describe a patient with
autoimmune pancreatitis who had renal "pseudotumor." In that
particular patient, there was also associated retroperitoneal fibrosis with
mediastinal and hilar adenopathy.
Although there was no pathologic diagnosis in our case shown in Figure 3,
the renal lesions may represent a systemic disease process of autoimmune
phenomena as Dr. Brennan and Dr. Pedrosa suggested.
References
- Kawamoto S, Siegelman SS, Hruban RH, Fishman EK. Lymphoplasmacytic
sclerosing pancreatitis with obstructive jaundice: CT and pathology features.
AJR 2004; 183:915
-921[Abstract/Free Full Text]
- Sahani DV, Kalva SP, Farrell J, et al. Autoimmune pancreatitis:
imaging features. Radiology 2004;233
: 345-352[Abstract/Free Full Text]
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