Hj. Mindell et al., ANATOMIC COMMUNICATIONS BETWEEN THE 3 RETROPERITONEAL SPACES - DETERMINATION BY CT-GUIDED INJECTIONS OF CONTRAST MATERIAL IN CADAVERS, American journal of roentgenology, 164(5), 1995, pp. 1173-1178
OBJECTIVE, A variety of retroperitoneal diseases such as pancreatitis,
infection, and trauma may cause fluid collections in the three major
retroperitoneal spaces, The purpose of our study was to elucidate flow
patterns of fluid between the various compartments to assist the clin
ical-radiologic assessment and treatment of various retroperitoneal di
seases, MATERIALS AND METHODS. In eight cadavers, CT guidance was used
to selectively inject 35-1000 mi of contrast medium by hand or power
injector into five perirenal, two posterior pararenal, and two anterio
r pararenal spaces, After the injections, CT of the entire abdomen and
pelvis was done with 10-mm-thick sections at intervals of 10-40 mm, A
ll images were reviewed in detail by a group of experienced body image
rs to assess the pathways of flow of contrast material between the thr
ee major retroperitoneal spaces, RESULTS, The caudal cone of perirenal
fascia was uniformly patent. A narrow channel connected the two perir
enal spaces in the midline; the posterior border of this channel abutt
ed the anterior margins of the abdominal aorta and the inferior vena c
ava. The perirenal, anterior pararenal, and posterior pararenal spaces
all communicated with the infrarenal space, which in turn connected w
ith the extraperitoneal spaces in the pelvis. When large quantities of
contrast medium are injected in the perirenal or pararenal spaces and
the infrarenal space is filled, the infrarenal space may then serve a
s a conduit across the midline of the abdomen. The anterior pararenal
space crossed the midline and had a distinct retrorenal extension but
no intraperitoneal connection, The slender posterior pararenal space h
ad an anterolateral extension en route to the prevesical space, CONCLU
SION, Our findings show pathways and extensions of the perirenal, ante
rior pararenal, and posterior pararenal spaces that should be consider
ed when assessing a variety of retroperitoneal diseases. Perinephric c
ollections, such as hematomas and urinomas, have at least a potential
conduit across the midline or into the pelvis, Our study explains how
blood from a ruptured abdominal aortic aneurysm may enter either perin
ephric space. Anterior pararenal processes, such as pancreatitis or ap
pendicitis, can extend into the pelvis or cross the midline, and poste
rior pararenal blood from trauma can also flow into the pelvis.