The perirenal space: relationship of pathologic processes to normal retroperitoneal anatomy

The perirenal space may be involved by disease processes that arise within or outside the perirenal space. Key anatomic details that dictate the features of perirenal processes include the renal capsule, the perirenal septa, the renal fascia, and the conic shape and inferomedial orientation of the perirenal space. Superiorly, the perirenal space is open to the bare area of the liver. The perirenal spaces communicate with one another at the level of the lower lumbar vertebrae. The hallmark of perirenal infection is localized or diffuse gas. Chronic urinoma appears as an encapsulated cystic mass, often aligned parallel with the perirenal space. Fat within an apparent spontaneous hematoma of the perirenal space suggests angiomyolipoma. Renal cell carcinoma, lymphoma, and melanoma are the most common causes of discrete solid masses in the perirenal space; metastases occur due to the characteristic lymphatic and vascular supply of the space. Amyloidosis and fibrosis create a nonspecific rind of soft tissue around the kidneys. Diaphragmatic pseudotumor produces a linear "lesion" in the perirenal space.