Radiological diagnosis of perinephric pathology: pictorial essay 2015

Abstract

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.

Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report

“…CTA was not used in the second patient who had already presented with hemodynamic instability, and bedside ultrasonography was performed for both patients. Ultrasonography can be fast and convenient to detect renal subcapsular fluid collection or perirenal hematoma [ 18 , 19 ], thus it is useful for rapid identification of RH, especially for patients who require expeditious intervention. Catheter angiography remains the golden standard for the diagnosis of RH, and it can clearly locate the bleeding sites and provide the chance for possible embolization simultaneously [ 14 , 15 ].…”

Case of perinephric abscess disguising as renal tumor

“…CT with contrast agent may show rim enhancement with central hypo-attenuation and thickened septa. 3 Increasing of adjacent fat signaling and thickening of perinephric fascia are suggestive of an infectious process rather than a neoplasm. 3 Radiologic findings of perinephric abscess and renal tumor on several imaging modalities can be seen on Table 1 .…”

“… 3 Increasing of adjacent fat signaling and thickening of perinephric fascia are suggestive of an infectious process rather than a neoplasm. 3 Radiologic findings of perinephric abscess and renal tumor on several imaging modalities can be seen on Table 1 . This case suggests perinephric abscess may have similar CT findings with renal tumor, due to alteration on renal margin.…”

“… 2 On the other side, malignant tumors with extra renal extension, perinephric hematoma, and urinoma may appear similar to perinephric abscess on imaging studies. 3 Thus, a thorough examination should be performed in diagnosing perinephric abscess. We describe an unusual case of chronic pyelonephritis with perinephric abscess in 64-year-old man diagnosed after showing non-specific clinical presentation, conflicting laboratory results and unusual imaging findings.…”

Hiding in Plain Sight: A Case of Perinephric Abscess Diagnosed by POCUS

“…The differential diagnosis for perinephric pathology with an anechoic appearance on ultrasound also includes perinephric hematoma, lymphangioma and pancreatic pseudocyst, whereas a heterogeneous echotexture can be seen in renal cell carcinoma, angiomyolipoma, lymphoma and liposarcoma. Chronic perinephric abscesses may have a heterogenous echotexture and thus be mistaken as a tumor and inappropriate over-gaining may compound this problem [5], both of which are potential explanations for initial misdiagnosis in this case.…”