Sun Wha Lee

Superior aspect of the perirenal space: Anatomy and pathological correlation

To study the anatomy of the superior aspect of the perirenal space, we analysed 50 computed tomographic (CT) scans with reference to the anatomy of Gerotas fascia, and dissected five cadavers laying special emphasis on the ascent of Gerotas fascia. We also reviewed 10 scans of patients with a large lesion in the right upper abdomen regarding localisation of the lesion. We conclude that Gerotas fascia does not cover the upper portion of the kidney and adrenal gland so that the superior aspect of the perirenal space is open towards the upper abdominal extraperitoneal space. Thus, a large lesion arising from the right adrenal gland or kidney easily invaginates the liver through the bare area mimicking a hepatic lesion, and vice versa. This explains the difficulty in localising a large lesion in the right upper abdomen.

Medial extent of the posterior renal fascia An anatomic and computed tomography study

To study the medial extent of the posterior renal fascia and the perirenal space, the authors dissected two cadavers and reviewed 50 computed tomographic (CT) abdominal scans. The results demonstrated that the medial extent of the posterior renal fascia depends on the level in a vertical direction and its relationship to the kidney which varies at different levels. At the renal hilus, the fascia inserts posteromedially to the fascia of the quadratus lumborum along its lateral margin; more cranially, the line of insertion is more lateral, onto the diaphragmatic fascia; more caudally, the line of insertion is more medial, inserting onto the anterior surface of the quadratus lumborum. Therefore the posteromedial insertion of the posterior renal fascia extends medially, from the more laterally placed diaphragmatic fascia, to the lateral margin of the quadratus lumborum and then to the anterior surface of the quadratus lumborum, depending on the anatomic level. The clinical implication of these findings are discussed.

Superior mediastinal widening from traumatic cerebrospinal fluid leak with spinal fracture

Superior mediastinal widening on chest radiograph in patients with trauma has been considered the hallmark of mediastinal hemorrhage. The usual causes of superior mediastinal widening are hematoma, aortic rupture, and rupture of the esophagus or tracheobronchial tree. Very rarely, a cause of superior mediastinal widening is leakage of the cerebrospinal fluid. This report descrbes a case of superior mediastinal widening from traumatic cerebrospinal fluid leakage with spinal fracture.