The perinephric space, shaped as an inverted cone, sits between the anterior and posterior renal fasciae. It can play host to a variety of clinical conditions encountered daily in the reporting schedule for a radiologist. Lesions may be classified and diagnosed based on their imaging characteristics, location and distribution. A broad range of differential diagnoses can be attributed to pathology sitting within this space, often without clinical signs or symptoms. An understanding of commonly encountered conditions affecting the perinephric space, along with characteristic imaging findings, can illustrate and often narrow the likely diagnosis. The aim of this essay is to describe commonly encountered neoplastic and non-neoplastic entities involving the perinephric space and to describe their key imaging characteristics.Teaching Point• Despite often a bulky disease, perinephric lymphoma does not produce obstruction or stenosis.• In primarily fatty masses, defects within the renal capsule likely represent angiomyolipoma.• Consider paraganglioma if biopsy is planned; biopsy may lead to catecholamine crisis.
A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.
Figure 1 An example of a smart angiography suite solution, from Tegus Medical. A highdefinition standalone camera allows a remote proctor to zoom into different aspects of the room to facilitate telecollaboration.
Purpose To outline the process of the STABILISE technique and its use; reporting patient outcomes and midterm follow up for complicated aortic dissection. Materials and methods Single centre retrospective analysis from January 2011 to January 2021 using the STABILISE technique which utilises balloon assistance to facilitate intimal disruption and promote aortic relamination. Results Sixteen patients underwent endovascular aortic repair with the STABILISE technique for aortic dissection over the study period. Fourteen patients (14/16; 88%) had acute dissection. Two of 16 (12%) were chronic. The median age of the patient cohort was 61 years (range 32–80 years) and consisted of a male majority (n = 11; 69%). The median time from diagnosis to intervention was 5 days (1–115 days; IQR 1–17.3). More than half (56%) had surgical repair of a acute type A aortic dissection prior to radiological intervention. The procedure was technically successful with no procedural mortality. Two patients were lost to follow up and two died in the post-operative period. Twelve patients had ongoing follow up with an average number of 2.9 ± 1.6 scans performed. Follow up was available in thirteen patients (81%) with a median follow up period of 1097 days (IQR 707–1657). The rate of re-intervention (n = 2/16; 13%) requiring additional stenting was in line with published re-intervention data (15%). Follow up showed a reduction in false lumen size following treatment with total luminal dimensions remaining stable over the follow-up period. Conclusion The STABILISE technique as a procedure for complicated aortic dissection, either acute or chronic, appears safe with stable mid-term aortic remodelling and patient outcomes. Level of evidence Level 3, Retrospective cohort study.
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