Roentgen Anatomy of Distribution and Localization of Collections

Selective opacification of the posterior pararenal space in the cadaver permits identification of the preferential pathway of spread and the characteristic localizing features. This is shown in Figure 8-188. The natural spread is inferior and lateral because of gravity, lumbar lordosis, and the fact that this space is open toward the flanks. The fluid density thus assumes an axis paralleling that of the psoas muscle and tends to displace the lower pole of the kidney laterally as well as anteriorly and upward. The kidney outline and perirenal fat shadows tend to be preserved. These features further distinguish these collections from effusions within the perirenal space. The psoas muscle shadow is obliterated by fluid collections, although it may actually be highlighted by gas collections. Further progression is shown by anterior and medial displacement of the ascending or descending colon and then encroachment on, or obliteration of, the flank stripe (Fig. 8-189).

The significant criteria for the localization and distinction of collections within the posterior pararenal space are outlined in Table 8-1 on page 360.

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