Helical CT evaluation of the perirenal space and its boundaries: a cadaveric study

To determine whether the perirenal spaces communicate across the midline and with the pelvic extraperitoneal spaces.

Helical CT was used to guide the sequential injection of 100-mL intravenous boluses of dilute contrast medium, up to 300 mL, into the perirenal space of eight embalmed cadavers (three male, five female; mean age at death, 82 years; range, 72-93 years), with four left-sided and four right-sided injections. All images were acquired after the final injection (300 mL total) to facilitate coronal and sagittal reconstruction of relevant images. All images were reviewed to assess the flow pathways of contrast medium from the perirenal space to other retroperitoneal spaces.

In three cadavers that received left perirenal space injections and in two cadavers that received right perirenal space injections, communication was seen with the contralateral perirenal space through an area anterior to the aorta and inferior vena cava. In three cadavers that received right perirenal space injections, contrast material flowed from the right perirenal space to outline the bare area of the liver. Communication between the perirenal and pelvic extraperitoneal spaces was seen in all eight cadavers; contrast material extended into the pelvic extraperitoneal and presacral spaces.

These findings show that the perirenal spaces communicate with each other across the midline and with the pelvic extraperitoneal spaces. Clinical implications are that perinephric collections can potentially flow into the pelvis or across the midline.