Roentgen Anatomy of Distribution and Localization of Collections

Selective opacification of the anterior pararenal space in the cadaver permits identification of the preferential pathway of spread and the characteristic localizing features, as shown in Figure 8-40. Preferential flow is downward to the iliac fossa, and the collection demonstrates several diagnostic features:

1. The general axis is vertical.

2. Medially, the collection overlaps the lateral border of the psoas muscle and approaches the spine.

3. Laterally, the lucent flank stripe is preserved, since flow is restricted by the lateroconal fascia.

4. Superiorly, the renal outline remains demarcated where the space lies anterior to the kidney. The hepatic or splenic outline, displaced from its bed of contrasting extraperitoneal fat, is lost. On the right, communication may be established across the reflections of the coronary ligament to the bare area of the liver. The occasional development of abscess in the bare area of the liver secondary to extraperitoneal infection, most commonly from appendicitis, is explained by this anatomic continuity with the anterior pararenal space (Fig. 8-41).

Figure 8-42 exquisitely confirms these findings in vivo. Figure 8-43 clarifies these relationships in the horizontal plane.

Fig. 8-39. Transverse anatomic section shows the hepatic angle embedded in extraperitoneal fat.

Infiltration of any of the three compartments as well as of the intraperitoneal space may result in loss of radiographic visualization of the hepatic angle. 1 = anterior pararenal fat; 2 = perirenal fat; 3 = posterior pararenal fat; 4 = intraperitoneal space; K = kidney; L = liver.

Perirenal Pararenal Fat

Fig. 8-39. Transverse anatomic section shows the hepatic angle embedded in extraperitoneal fat.

Infiltration of any of the three compartments as well as of the intraperitoneal space may result in loss of radiographic visualization of the hepatic angle. 1 = anterior pararenal fat; 2 = perirenal fat; 3 = posterior pararenal fat; 4 = intraperitoneal space; K = kidney; L = liver.

The significant criteria for the radiologic localization and distinction of collections within the anterior pararenal space are outlined in Table 8-1.

Was this article helpful?

0 0
Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Post a comment