The role of barium contrast studies in the diagnosis of retroperitoneal tumors.

Abstract

The radiologist is walking along an ever narrowing tightrope in the investigation of a patient with a poorly defined symptom complex. It is easy to stumble between the dangers of the well publicized limits of total-body irradiation and the risk of missing an elusive lesion because of inadequate examination. For this reason roentgenographic procedures should be constantly reappraised to make certain that the simplest possible technics offering the greatest possible rewards are used. The study of retroperitoneal tumors emphasizes this problem. The inaccessibility of the retroperitoneal space masks early symptoms and makes physical diagnosis uncertain. This has led to the development of complex and difficult, though specific, roentgenographic procedures, permitting more accurate evaluation. These complex procedures have in turn increased the value of the comparatively simpler and safer method of barium studies of the digestive tract in the search for retroperitoneal masses. The distortions and the displacements of gastrointestinal structures noted during such routine examinations have taken on increased significance in view of the knowledge gained by investigations utilizing pneumography and aortography. Barium contrast studies, therefore, have become an accurate method, serving multiple purposes while keeping their chief advantage of simplicity. It is the purpose of this review to assay the role of barium contrast examination in the diagnosis of retroperitoneal tumors. Such a study is the pivot for an investigation of the patient with an abdominal mass or with vague complaints referred to the abdomen. Its primary function is to exclude intrinsic lesions of the gastrointestinal tract. It is a grossly sensitive indicator in an evaluation of abdominal masses already known to be present. At times, it serves to detect and delineate unsuspected masses. In every instance, it is useful in directing the need and nature of subsequent roentgenographic studies. The limitations of the barium contrast study should be noted at the onset of this evaluation. 1. Such studies are nonspecific, since displacement of a barium- or an air-filled hollow organ may be produced by any mass, whether neoplastic or inflammatory in origin. 2. The principal function of these studies is to provide a precise topographic analysis of the masses producing displacement of adjacent structures. Often, however, the desired goal is merely approximated. 3. The critical size of the mass determines the efficiency of the study. The mass must be large enough to produce indentation or displacement of the bowel loops. Paradoxically, very large masses that fill the abdomen and displace the bowel loops and viscera to a marked degree often defy evaluation by barium contrast methods. 4. The barium contrast studies obviously fail in the presence of masses which follow the contour of the retroperitoneal space, with no anterior projection (Fig. 1).