Ultrasonography of changes in the retroperitoneal vessels and perivascular spaces during retroviral infection: preliminary results

The abdomen in patients with acquired immunodeficiency syndrome (AIDS) is subject to various damage. In AIDS patients, manifestations in the retroperitoneal region, including apparent changes in the pancreas, kidney and lymph nodes, have been well described in the radiological literature. However, abnormalities of the vessels and perivascular spaces have not been well investigated in this syndrome. We performed abdominal sonography in 10 patients who were seropositive for HIV. They had no history of known risk factors such as drug abuse or homosexuality. Also, 4 healthy male controls were examined for comparison. Our aim was to demonstrate and to characterize the pathological changes of the retroperitoneal vessels and perivascular spaces from sonographic observations. The sonographic evaluation included determination of the morphologic and dynamic aspects of the aorta, vena cava and superior mesenteric vessels. The echostructure of the perivascular spaces was analyzed. In this prospective and preliminary study, we have not considered the presence of an AIDS condition. We have precisely analyzed the upper umbilical areas. In all cases, there were supposed to be the same landmarks. The sonographic scans were obtained through the left renal and mesenteric vessel areas, essentially through axial scans. In all 10 patients, sonography showed at least two abnormalities. Three patients had abnormal echostructural changes in all the sites. The images showed echostructural disorganization with poor definition and "fuzzy" and "dirty" aspects of the retroperitoneal vessels and perivascular spaces. The aorta was normal in 2 patients and abnormal in 8 patients with diminished hyperechography and regularity of the aortal wall. The aortic diameter was smaller than 1.5 cm in 7 cases, with a significant attenuation of the beating of the aorta. Despite these abnormalities, the aorta had a normal left paramedian position ahead of the rachis. The inferior vena cava was normal in 1 case and abnormal in 9 cases with diminished hyperechography and regularity of the wall. The vena cava position was normal in 4 cases, displaced in 6, and laminated in 3. The superior mesenteric vessels were abnormal in 8 cases, with poorly defined aims in 6, an indefinite position in 2, and spreading in 2. Adenopathy was present in 6 patients, multiple in 5 and singular in 1 case. A retrocaval location was always observed. A perivascular infiltration and thickening was noted which was diffuse in 6 c