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Answer 1
  1. CT scan of the abdomen and pelvis. RPF has a subtle presentation that often makes the diagnosis difficult. This patient has the classic description of RPF (ie, poorly localized and constant abdominal or flank pain, malaise, anorexia, weight loss, and evidence of ureteral obstruction with hydronephrosis on ultrasound), but other pathologic processes (especially malignancy) must be excluded. Given this patient’s normal serum creatinine level, a CT scan of the abdomen and pelvis is the examination of choice to visualize the extent of fibrosis and exclude other pathology.1 MRI is a useful alternative to CT scanning in patients with impaired renal function. IVP and cystoscopy with bilateral retrograde pyelograms are often used in the evaluation of RPF and show characteristic medial deviation of the middle third of the ureter; however, they will not demonstrate other etiologies of the patient’s presenting symptoms as well as a CT scan.

    1. Feinstein RS, Gatewood OM, Goldman SM, et al. Computerized tomography in the diagnosis of retroperitoneal fibrosis. J Urol 1981;126:255-9.

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