Clinical Investigations

Plain abdominal X-ray, barium enema or an intravenous pyelogram may suggest the presence of a retroperitoneal tumour due to distortion of normal structures. However, the investigations of choice are ultrasonography, CT scanning or magnetic resonance imaging (MRI). Arteriography may also be useful, particularly if resection of a large tumour is contemplated. Historically, lymphangiograpy was the investigation of choice in the evaluation of lymphadenopathy in the retroperitoneum. Now CT scanning is more commmonly performed. Whilst CT is very good at detecting large nodal masses associated with malignant lymphoma, it is less effective in the assessment of metastatic disease to the pelvic and retroperitoneal nodes. The status of pelvic and retroperitoneal lymph nodes is particularly important in patients with stage 1 non-seminoma-tous malignant germ cell tumours of the testis for reasons discussed later and positron emission tomography (PET) scanning is currently being evaluated as an alternative imaging modality in the context of a clinical trial.

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