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Neoplastic and Non-neoplastic Proliferative Disorders of the Perirenal Space: Cross-sectional Imaging Findings¹

¹ From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.R.S., S.R.P., A.H.P., A.N., N.C.D.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (C.M.). Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received July 11, 2007; revision requested September 11, 2007, and received January 4, 2008; accepted January 30. All authors have no financial relationships to disclose. Address correspondence to S.R.P. (e-mail: prasads{at}uthscsa.edu).

The perirenal space, located between the anterior and the posterior renal fasciae, is shaped like an inverted cone with an apex that extends into the iliac fossa. Perirenal tumors and pseudotumors primarily originate either from the kidney or as part of a systemic disease process and have characteristic histopathologic features and biologic behavior. The lesions may be classified on the basis of their distribution and imaging features as solitary soft-tissue masses (renal cell carcinoma, lymphangioma, hemangioma, and leiomyoma), rindlike soft-tissue lesions (lymphoma, retroperitoneal fibrosis, and Erdheim-Chester disease), masses containing macroscopic fat (angiomyolipoma, liposarcoma, myelolipoma, and extramedullary hematopoiesis), and multifocal soft-tissue masses (metastases, plasma cell tumors). Because of overlap in imaging findings among these diverse perirenal lesions, a definitive diagnosis in most cases can be established only at histopathologic analysis. However, an imaging pattern–based approach may facilitate the diagnosis and optimal management of perirenal tumors and pseudotumors.

© RSNA, 2008