Mindell H J, Mastromatteo J F, Dickey K W, Sturtevant N V, Shuman W P, Oliver C L, Leister K L, Barth R A
Department of Radiology, Fletcher Allen Health Care, Burlington, VT 05401, USA.
AJR Am J Roentgenol. 1995 May;164(5):1173-8. doi: 10.2214/ajr.164.5.7717227.
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 clinical-radiologic assessment and treatment of various retroperitoneal diseases.
In eight cadavers, CT guidance was used to selectively inject 35-1000 ml of contrast medium by hand or power injector into five perirenal, two posterior pararenal, and two anterior 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. All images were reviewed in detail by a group of experienced body imagers to assess the pathways of flow of contrast material between the three major retroperitoneal spaces.
The caudal cone of perirenal fascia was uniformly patent. A narrow channel connected the two perirenal spaces in the midline; the posterior border of this channel abutted the anterior margins of the abdominal aorta and the inferior vena cava. The perirenal, anterior pararenal, and posterior pararenal spaces all communicated with the infrarenal space, which in turn connected with 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 as 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 had an anterolateral extension en route to the prevesical space.
Our findings show pathways and extensions of the perirenal, anterior pararenal, and posterior pararenal spaces that should be considered when assessing a variety of retroperitoneal diseases. Perinephric collections, 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 perinephric space. Anterior pararenal processes, such as pancreatitis or appendicitis, can extend into the pelvis or cross the midline, and posterior pararenal blood from trauma can also flow into the pelvis.
多种腹膜后疾病，如胰腺炎、感染和创伤，可能导致腹膜后三大间隙出现液体积聚。本研究的目的是阐明各间隙之间液体的流动模式，以辅助各种腹膜后疾病的临床 - 放射学评估及治疗。
在8具尸体上，采用CT引导，通过手动或动力注射器将35 - 1000毫升造影剂选择性地注入五个肾周间隙、两个肾后间隙和两个肾前间隙。注射后，对整个腹部和骨盆进行CT扫描，层厚10毫米，间隔10 - 40毫米。一组经验丰富的体部影像专家详细审查所有图像，以评估造影剂在腹膜后三大间隙之间的流动路径。
肾周筋膜的尾侧圆锥始终通畅。一条狭窄通道在中线连接两个肾周间隙；该通道的后缘邻接腹主动脉和下腔静脉的前缘。肾周间隙、肾前间隙和肾后间隙均与肾下间隙相通，肾下间隙又与盆腔的腹膜外间隙相连。当在肾周或肾旁间隙注入大量造影剂且肾下间隙被填满时，肾下间隙可作为穿过腹部中线的通道。肾前间隙穿过中线，有明显的肾后延伸，但无腹腔内连接。纤细的肾后间隙有一个向前外侧的延伸，通向膀胱前间隙。
我们的研究结果显示了肾周、肾前和肾后间隙的路径及延伸情况，在评估各种腹膜后疾病时应予以考虑。肾周积液，如血肿和尿外渗，至少有潜在的穿过中线或进入盆腔的通道。我们的研究解释了腹主动脉瘤破裂的血液如何进入任一肾周间隙。肾前病变，如胰腺炎或阑尾炎，可延伸至盆腔或穿过中线，创伤导致的肾后出血也可流入盆腔。
