Anatomical communications of the perirenal space

There are controversies over the anatomical communications between the perirenal space and the adjacent extraperitoneal spaces. Clinical studies, mainly based on CT, show fluid collections extending into the adjacent space; into the bare area of the liver on the right, into the superior extraperitoneal space on the left, towards the midline from each perirenal space, and into the lower retroperitoneal space of the abdomen and pelvis. There are certain constant anatomical barriers limiting free extension of fluid or pathology. The pattern of fluid collection in the perirenal space and extension into the adjacent extraperitoneal space is relatively consistent although it varies with the amount and nature of the pathological fluid collection. This pictorial review illustrates anatomical barriers and CT findings of perirenal fluid collections and their extension into adjacent extraperitoneal spaces.