Gastrointestinal Radiology

, Volume 12, Issue 1, pp 121–127 | Cite as

Pancreatic lesions and transfascial perirenal spread: Computed tomographic demonstration

  • Michiel A. M. Feldberg
  • Martin J. Hendriks
  • Paul F. G. M. van Waes
  • Ki J. Sung
Article

Abstract

Computed tomographic (CT) findings in 105 cases of pancreatitis and 107 cases of pancreatic carcinoma were analyzed retrospectively to determine the occurrence and roentgenologic signs of penetration of the anterior renal fascial planes in relation to clinical symptoms. In pancreatitis, the perirenal fat was infiltrated in 7% to variable extents by extrapancreatic fluid collections, either as asymptomatic fluid lying alongside renal fascial planes and perirenal septa (5 cases) or as well-circumscribed fluid collections causing clinical symptoms (2 cases). In pancreatic carcinoma the occurrence of retropancreatic extension to a perirenal space was rarer (3%). Distinction on CT between perirenal involvement from the pancreas and primary adrenal or renal lesions with anterior spread can prevent unnecessary surgery.

Key words

Pancreas, computed tomography Pancreatitis Pancreas, neoplasms Retroperitoneum, computed tomography 

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References

  1. 1.
    Abeshouse BS: The differential diagnosis of pancreatic and renal disease with particular emphasis on differentiating pancreatic cysts from renal cysts.Int Abst Surg 96:1–28, 1953Google Scholar
  2. 2.
    Surmonte JA, Miller JM, Ginsberg M, Meisel HJ: Pseudocyst of the pancreas simulating diseases of the kidney.J Urol 81:606–608, 1959Google Scholar
  3. 3.
    Thompson GJ, Culp OS: Perplexing cystic masses near the kidney.J Urol 89:370–376, 1963Google Scholar
  4. 4.
    Marshall S, Lapp M, Schulte JW: Lesions of the pancreas mimicking renal disease.J Urol 93:41–45, 1965Google Scholar
  5. 5.
    Gorder JL, Stargardter FL: Pancreatic pseudocysts simulating intrarenal masses.AJR 107:65–68, 1969Google Scholar
  6. 6.
    Hellebusch AA, Walton KN, Griffen WO: Perinephric pancreatic pseudocyst in a child.J Urol 102:633–634, 1969Google Scholar
  7. 7.
    Guerrier K, Persky L: Pancreatic disease simulating renal abnormality.Am J Surg 120:46–49, 1970Google Scholar
  8. 8.
    Stept LA, Johnson SH III, Marshall M, Price SE: Intrarenal pancreatic disease.J Urol 106:15–18, 1971Google Scholar
  9. 9.
    Kiviat MD, Miller EV, Ansell JS: Pseudocysts of the pancreas presenting as renal mass lesions.Br J Urol 43:257–262, 1971Google Scholar
  10. 10.
    Atkinson GO, Clements JL Jr, Milledge RD, Weens HS: Pancreatic disease simulating urinary tract disease.Clin Radiol 24:185–191, 1973Google Scholar
  11. 11.
    Heckmann HH, Clapp PR, Lowney B, Fuchs JE, Olsson CA: Pancreatic pseudocyst simulating perinephric abscess.Urology 5:420–423, 1975Google Scholar
  12. 12.
    Naftel W, Ravera J, Herr HW: Pseudocyst of the pancreas simulating a renal neoplasm.Urology 5:417–419, 1975Google Scholar
  13. 13.
    DeTakats G, Mackenzie WD: Acute pancreatic necrosis and its sequelae.Ann Surg 96:418–440, 1932Google Scholar
  14. 14.
    Honigmann F:Dtsch Zeitschr Chir 80:19, 1905Google Scholar
  15. 15.
    Trattner HR, Galvin JB: Acute pancreatitis with involvement of pararenal and perirenal fat simulating acute perinephric abscess. Case report.Urol Cutan Rev 44:409–411, 1940Google Scholar
  16. 16.
    Ormond JK, Wadsworth GH, Morley HV: Pancreatic lesions confusing urologic diagnosis: report of three cases.J Urol 48:650–657, 1942Google Scholar
  17. 17.
    Stone EP: Pancreatic cyst simulating renal disease.J Urol 62:104–117, 1949Google Scholar
  18. 18.
    Balthazar EJ, Ranson JHC, Naidich DP, Megibow AJ, Caccavale R, Cooper MM: Acute pancreatitis: prognostic value of CT.Radiology 156:767–772, 1985Google Scholar
  19. 19.
    Stanley RJ, Sagel SS, Levitt RG: Computed tomographic evaluation of the pancreas.Radiology 124:715–722, 1977Google Scholar
  20. 20.
    Mendez G, Isikoff MB, Hill MC: CT of the acute pancreatitis: interim assessment.AJR 135:463–469, 1980Google Scholar
  21. 21.
    Love L, Meyers MA, Churchill RJ, Reynes CJ, Moncada R, Gibson D: Computed tomography of extraperitoneal spaces.AJR 136:781–789, 1981Google Scholar
  22. 22.
    Alexander ES, Colley DP, Clark RA: CT of retroperitoneal fluid collections.Semin Roentgenol 16:268–276, 1981Google Scholar
  23. 23.
    Baker DE, Glazer GM: Bilateral pararenal calcifications resulting from pancreatitis.AJR 143:51–52, 1984Google Scholar
  24. 24.
    Baker MK, Kopecky KK, Wass JL: Perirenal pancreatic pseudocyst: diagnostic management.AJR 140:729–732, 1983Google Scholar
  25. 25.
    Morehouse HT, Thornhill BA, Alterman DD: Right ureteral obstruction with pancreatitis.Urol Radiol 7:150–152, 1985Google Scholar
  26. 26.
    Raptopoulos V, Kleinman PK, Marks S Jr, Snyder M, Silverman PM: Renal fascial pathway: posterior extension of pancreatic effusions within the anterior pararenal space.Radiology 158:367–374, 1986Google Scholar
  27. 27.
    White EM, Wittenberg J, Mueller PR, Simeone JF, Butch RJ, Warshaw AL, Neff CC, Nardi GL, Ferrucci JT Jr: Pancreatic necrosis: CT manifestations.Radiology 158:343–346, 1986Google Scholar
  28. 28.
    Havrilla TR, Haaga JR, Reich NE, Seidelmann F: Pseudocyst of the pancreas with perirenal extension: demonstration by computed tomography.Comput Axial Tomogr 1:199–203, 1977Google Scholar
  29. 29.
    Rauch RF, Korobkin M, Silverman PM, Dunnick NR: Subcapsular pancreatic pseudocyst of the kidney.J Comput Assist Tomogr 7:536–538, 1983Google Scholar
  30. 30.
    Rubenstein WA, Auh YJ, Zirinsky K, Kneeland JB, Whalen JP, Kazam E: Posterior peritoneal recesses: assessment using CT.Radiology 156:461–468, 1985Google Scholar
  31. 31.
    Nicholson RL: Abnormalities of the perinephric fascia and fat in pancreatitis.Radiology 139:125–127, 1981Google Scholar
  32. 32.
    Fishman EK, Siegelman SS: Computed tomography of pancreatic carcinoma. In Siegelman SS (ed):Computed Tomography of the Pancreas. New York: Churchill-Livingstone, 1983Google Scholar
  33. 33.
    Freeny PC, Lawson TL:Radiology of the Pancreas. New York: Springer Verlag, 1982Google Scholar
  34. 34.
    Haaga JR: The pancreas. In: Haaga JR, Alfidi RJ (eds):Computed Tomography of the Whole Body. St. Louis: C.V. Mosby, 1983Google Scholar
  35. 35.
    Stark DD, Moss AA, Goldberg HI, Deveney CW: CT of pancreatic islet cell tumors.Radiology 150:491–494, 1984Google Scholar
  36. 36.
    Lamki N, Raval B: Computed tomography in pararenal and perirenal lesions.J Comput Tomogr 6:237–243, 1982Google Scholar
  37. 37.
    Oliphant M, Berne AS: Computed tomography of the subperitoneal spaces: demonstration of direct spread of intraabdominal disease.J Comput Assist Tomogr 6:1127–1137, 1982Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1987

Authors and Affiliations

  • Michiel A. M. Feldberg
    • 1
  • Martin J. Hendriks
    • 1
  • Paul F. G. M. van Waes
    • 1
  • Ki J. Sung
    • 1
  1. 1.Department of RadiodiagnosisUtrecht University HospitalUtrechtThe Netherlands

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