Acute conditions affecting the perinephric space: imaging anatomy, pathways of disease spread, and differential diagnosis

Abstract

The perinephric space is an important, central compartment of the retroperitoneum which may host various acute conditions. Imaging evaluation of the perinephric space requires an understanding of its anatomy and the pathways of disease spread to and from other retroperitoneal compartments. Numerous acute conditions can affect the perinephric space and may occur in isolation, extend from nearby retroperitoneal structures, or be part of a systemic condition. Familiarity with the key imaging findings of acute conditions affecting the perinephric space is imperative to facilitate diagnosis and guide treatment. The purpose of this article is to review and illustrate the relevant anatomy, pathways of disease spread, and acute pathology encountered during cross-sectional imaging evaluation of the perinephric space.

Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis

“…Transdiaphragmatic lymphatics communicate with perinephric lymphatic channels, and can serve as potential routes of communication between the thorax and the abdomen [10]. Several case reports have described extension of urine from disrupted renal collecting system or bladder injury into the thorax, resulting in thoracic urinomas [11][12][13].…”

Radiological diagnosis of perinephric pathology: pictorial essay 2015

“…Medially, the perinephric fascial extension joins the periureteral connective tissue and duodenal attachments on the right, whilst on the left its attachment is seen to extend towards the periaortocaval connective tissue. Superiorly, it attaches to the diaphragm, whilst it continues and attaches to the iliac fascia inferiorly as a combined inter-fascial plane [3]. …”

“…The posterior pararenal space sits between Zuckerkandl’s fascia and the transversalis fascia, and contains no organs, only fat pads. As the inter-fascial plane continues towards the iliac fascia, the space produced between Gerota’s fascia and Zuckerkandl’s fascia is known as the infrarenal space [1, 3]. …”

“…It is important to remember to inspect the entire urinary system to identify the primary cause of leakage, especially in cases secondary to ureteral obstruction. In cases of diagnostic dilemma, fine needle aspiration with measurement of fluid creatinine can be diagnostic [3].

Fig.

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“…A urinoma may present with gross fibrous thickening and an enhancing rim and septa on contrast-enhanced CT [3]. …”