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<p> <div><p> Infectious and inflammatory. The septum of Bertin is an invagination of renal cortex down to the renal sinus. This extension of tissue resembles normal cortex and is isoechoic, obviating the need for further investigations. Each column consists of lines of blood vessels and urinary tubes and a fibrous material. In this case report we present a patient with HCB, which mimics renal mass in ultrasonography (US) examination with its US, Doppler US and magnetic resonance imaging (MRI) findings. In addition, MRI does not have This column occasionally hypertrophies and causes splaying of the calyces. Collecting system: consists of the infundibulum and renal pelvis: 1. It extends from the renal cortex to the renal sinus and is located between two medullary pyramids. Hypertrophied column of Bertin, or focal cortical hyperplasia, is defined as bands of hypertrophic cortical tissue located between the pyramids of the renal medulla. renal tuberculosis. The renal columns (columns of Bertin) are cortical tissue between renal papillae. Column of Bertin Hypertrophy. 초음파 검사 정상범위는 9~13 cm이며 나이, 성별, 체형, 수분 공급 상태에 따라 차이가 있다. A hypertrophied renal column (or renal . Fusion anomalies occur during the cranial migration of the kidneys from the pelvis to the lumbar region. 측정 방향이 부적절하면 실제보다 작게 평가된다 . The columns of Bertin are normal structures seen in the renal cortical tissue. 1–3 Prominent column of Bertin can become hypertrophied with incomplete fusion of fetal lobes giv-ing off double thickness, mimicking renal masses. Hypertrophic column of Bertin is isodense/isointense with the normal renal parenchyma on non-contrast- and contrast-material enhanced CT or MR images and MRI examination is more sensitive than CT [2, 4]. They may be classified as anomalies of renal form, which are . hypertrophied column of Bertin indenting the sinus fat in the mid kidney. renal abscess. There was a prominent area of normal renal tissue in the upper pole of the left kidney with maintained cortico-medullary differentiation on the cortico-medually phase imaging (best seen on coronals). Prominent columns of Bertin (PCBs), also known as hypertrophic column of Bertin, are areas of normal cor-tical renal tissues that extend and can surround the renal pyramids. Hypertrophic column of Bertin is isodense at CT and isointense at MRI to the normal renal parenchyma. Particularly prominent, hypertrophied columns of Bertin may mimic a renal tumour. scarred kidney. It merges with the cortex and causes no contour deformity. Partial or complete renal duplication 2. Extrarenal calyces. 신장 길이 측정 시 주의점은 탐촉자를 조절하여 가장 긴 축을 재야한다. column (Fig. Index. (Since all elements of the tissue are normal, that is, neither hypertrophic nor a displaced or embryonic rest, it is referred to as . Dromedary humps are prominent focal bulges on the lateral border of the left kidney. (2023). Congenital causes including hypertrophied column of Bertin, persistent fetal lobulation, spleno-renal fusion and dromedary humps. PMID: 1438753. Columns of Bertin (Fig. Persistent Fetal Lobulations 신장의 평균 길이는 11~12 cm, 폭은 6 cm 정도이다. A hypertrophied column shows enhancement that is the same as normal cortex. The renal column (or Bertin column, or column of Bertin) is an extension of the renal cortex in between the renal pyramids. (Since all elements of the tissue are . umns of Bertin are isoechoic to slightly hyperechoic compared with adjacent normal renal cortex (Fig. 20). The tissue is often located in the middle one-third of the kidney between the upper and middle calyces. Baby Kidney (Persistent Fetal Lobulation) and Hypertrophied Column of Bertin (Prominent Column of Bertin). These pitfalls are easily avoided on CT and MRI, because the attenuation, signal intensity, and enhancement are identical to those of normal renal cortical tissue in all phases and sequences ( 11), as shown in Figures 6A and 6B. hypertrophied column of Bertin- normal renal cortex projecting into the renal sinus; can present as a renal pseudotumor. Exploiting Ideology and Making Higher Education Serve Vietnam’s Authoritarian Regime. CT is the main imaging modality for evaluating renal pathology in adults but is less preferred in pediatrics because of lower incidence of stones and malignancies in children and to avoid ionizing radiation exposure. Hypertrophied column of Bertin. . C: Sagittal ultrasound showing a mass-like area in the left kidney. B. [2, 3] It often invaginates into the renal sinus, and is most often located between upper and middle calyxes. The absence of renal contour . The reason for this difference may be that here CT images were evaluated using 3-mm sections, whereas Lafortune et al. They are normal variants of the renal contour, caused by the splenic impression onto the superolateral left kidney. It contains renal cortex, pyramids, and columns (septa) of Bertin. renal malakoplakia . Figure 6. Dromedary hump, hypertrophied column of Bertin, and persistent fetal lobulation. No true mass identified on CT. 3;and #{231},11-C). In: Metaphorical Signs in Computed Tomography of Chest and Abdomen. Computed tomography (CT) scanning with contrast is superior to ultrasonography and excretory urography in diagnosing the nubbin. Water bath sonograms of normal cadaver kidneys and subsequent anatomic correlation revealed hypertrophied columns and . Key to correct identification of a hypertrophied column of Bertin is the fact that it is in continuity with, and of similar appearance to, normal renal cortical parenchyma, and that the renal outline is preserved. Hypertrophied Column of Bertin. The kidneys cross the umbilical arteries, and any change in arterial position may cause fusion of nephrogenic blastema. The so-called hypertrophic column of Bertin is a normal variation and simply represents unresorbed polar parenchyma of one or both of the two subkidneys that fuse to form a normal kidney. dromedary hump. They become of radiographic importance when they are unusually enlarged an may be mistaken for a renal mass ( renal pseudotumor ). 1438753. Radiographic features. The fusion may Hypertrophic column of Bertin is isodense/isointense with the normal renal parenchyma on non-contrast- and contrast-material enhanced CT or MR images and MRI exami-nation is more sensitive than CT [2, 4]. a hypertrophied column of Bertin, and a dromedary hump. The infundibulum is composed of minor and major calyces: On contrast-enhanced CT and MRI, the enhancement pattern in a column of Bertin should be identical to the renal cortex on all phases-this is most evident on the corticomedullary phase (Fig. cross-fused renal ectopia. In other words, the column of Bertin is isoechoic to the normal renal parenchyma on renal US and has identical density to the normal renal parenchyma on unenhanced CT and magnetic resonance imaging (MRI) and all phases of enhanced CT and MRI as well. splenorenal fusion. Renal hypoplasia. 54,55 In children, CT without contrast is the recommended imaging modality for evaluation of suspected urolithiasis after an . xanthogranulomatous pyelonephritis (XGP) renal sarcoidosis. Renal sinus appears hyperechoic compared to the renal parenchyma, contains blood vessels 3 The urothelium layer within the renal sinus also appears as hyperechoic. The CT scan is consistent with a column of Bertin (centre image, arrow). The renal column of Bertin is a medullary extension of the renal cortex in between the renal pyramids. While considered an anatomical variant, duplex . They were bilateral in 18%. CT in a 37-year-old woman with hypertrophied column of Bertin. A column of Bertin is the extension of renal cortical tissue which separates the pyramids, and as such are normal structures. prominent column of Bertin. How to differentiate it from a real renal mass? HCBRenal tumor 1. Figure 6 Dromedary hump, hypertrophied column of Bertin, and persistent fetal lobulation. They are usually located in the mid-portion of the kidney and . On a CT scan, a large column of Bertin can mimic a duplex collecting system. 185. renal hilar lip. CECT is often done to resolve the issue. Citation, DOI, disclosures and article data. The term “dromedary hump” or “splenic hump” refers to a bulge in the middle of the lateral surface of the left renal cortex. Adimple on the cortical surface margin opposite the column isoccasionally seen and represents the normal raphe on the surface of the kidney asdescribed byHodson) MA1ERIAL During the period ofthe past ear we have seen 10 cases demonstrating the characteristic findings of a column of Bertin. The column of Bertin originally described in 1744 is now a common uroradiologic finding which becomes radiographically and thus clinically significant when it simulates an intrarenal mass on the excretory urogram. They are usually located in the mid-portion of the kidney and are more commonly found on the left side 4. On longitudinal section, it . Prominent columns of Bertin, bulging of the renal contour and focal renal hypertrophy can look like a renal mass on ultrasound, unenhanced images and CT in the nephrogenic phase. Thuy Nguyen, Communist and Post-Communist Studies, 2022. ) Each column consists of lines of blood vessels and urinary tubes and a fibrous material. A hypertrophied column of Bertin is one of the congenital causes of renal pseudo tumor. Unusually large or atypical presentation of the prominent columns (septa) of Bertin on sonography may lead to further imaging, such as CT or MRI of the kidneys, to rule out an intrarenal tumor (Fig. [ 3 ] evaluated ultrasonography images. It occurs at the junctions of original fetal lobulations and is present in Duplex systems, (see above) dividing the two moieties. On excretory urography, an obstructed, nonfunctioning upper or lower pole may mimic a renal mass. This pseudomass typically occurs between upper and interpolar calyces and is more common on the left. Hypertrophic column of Bertin (HCB) may mimic renal mass and may lead to unnecessary nephrectomy in some conditions. The 99m Tc-DMSA single-photon emission CT/CT was performed on the GE Millenium VG with Hawkeye (GE Healthcare, Chalfort St Giles, UK), giving comparably low CT image quality, but the corresponding sections confirm uptake similar to normal renal parenchyma consistent with a . Most were located in the middle third of the kidney, more frequently on the left side. [3] Hypertrophic column of Bertin is isodense at CT and isointense at MRI to the normal renal parenchyma. Case Discussion. Usually isoechoic with rest of the…. As the column of Bertin is protruding into the renal sinus, it has a typically conical shape on . It is usually created by the pressure of surrounding organs to the cortex of the kidney during development. Contrast-enhanced imaging (US, CT, and MR) will show the same enhancement pattern of the surrounding renal parenchyma (Figures 3(a) , 3(b) , and and4) 4 ) allowing the differential diagnosis between pseudotumors and infiltrative solid renal . 2) can be found bilaterally and represents continuation of the normal renal cortex towards the renal sinus fat secondary to hypertrophy. In the corticomedullary phase the normal corticomedullary pattern in these pseudotumors can be appreciated, distinguishing them from real lesions. A duplex collecting system, or duplicated collecting system, is one of the most common congenital renal tract abnormalities. Cite this chapter. Unusually large or atypical presentation of the prominent columns (septa ) of Bertin on sonog-raphy may lead to further imaging, such as CT or MRI of the kidneys, to rule out an intrarenal tumor (Fig. Lafortune et al. The findings are consistent with a benign prominent column of Bertin (normal parenchyma). hypertrophied column of Bertin which is isoechoic to renal cortex . , Communist and Post-Communist Studies, 2023. On ultrasound the column splits the sinus echoes. Acquired causes in cases of CKD, known in the literature as “regenerating nodules” or “focal nodules of compensatory hypertrophy” which we elect to call FPT. Contrast-enhanced imaging (US, CT, and MR) will show the same enhancement pattern of the surrounding renal parenchyma (Figures 3(a) , 3(b) , and 4 ) allowing the differential diagnosis between pseudotumors and infiltrative solid renal lesion . The upper urinary tract is the most common human system affected by congenital anomalies. 4,5 On Hypertrophied columns of Bertin are isoechoic to slightly hyperechoic compared with adjacent normal renal cortex . The congenital enlargement of the renal columns is usually located at the hilar level of the kidney and may be mistaken for a renal mass . granulomatous renal disease. Dromedary humps are important because they may mimic a renal mass, and as such is considered a renal . HCB shows the same enhancement pattern with normal renal parenchyma on dynamic MRI, as in our case. The first were . Medial opening into the renal sinus at the mid portion of the kidney. They become of radiographic importance when they are unusually enlarged an may be mistaken for a renal mass ( renal pseudotumour ). The column of Bertin has an echogenicity, attenuation value, and signal intensity that is equal to or slightly greater than that of the cortex. Gender: Female. CT features typical of hypertrophied column of Bertin that should not be mistaken for renal mass. 2% (22/136 kidneys), whereas here, the incidence of a prominent column of Bertin was almost double that. Developmental anomalies of the kidneys and ureters are numerous and not only potentially render image interpretation confusing but also, in many instances, make the kidneys more prone to pathology: number. 1). (Cortical extensions into the medullary space. ( B ) Corticomedullary phase reveals the masslike structure with similar corticomedullary differentiation as the rest of the renal parenchyma ( arrow ), consistent with a hypertrophied column . Through it passes the renal arteries, veins, nerves, lymphatic vessels, and ureter. This is a common cause of renal "pseudomass". —A hypertrophied column of Bertin, or focal cortical hyperplasia, is characterized by hypertrophied cortical tissue located between the pyramids of the renal medulla, projecting into the renal sinus . 1148/radiology. 1A, 1B, 1C). Enhanced MR of the previous patient (performed for another renal lesion, not shown) shows that the lesion has the same . The parts dipping in between the pyramids are named the renal columns (Bertini), while the portions which connect the renal columns to each other and intervene between the bases of the pyramids and the fibrous tunic are called the cortical arches. persistent fetal lobulation. It is also frequently found unilaterally on the left side. Nephrotomography is a definitive diagnostic study when the following features are seen: 1. pyelonephritis. These are called columns of Bertin. 3. Hypertrophic column of Bertin (HCB) is a normal variant that appears as a mass that extends towards renal sinus. ( A ) Nephrographic phase demonstrates masslike structure ( arrow ) in the right midkidney. Congenital anomalies of the kidneys and ureters comprise a wide spectrum of disorders ranging from simple variants with no clinical significance to complex anomalies that may lead to severe complications and end-stage renal disease. 6. It is characterized by an incomplete fusion of upper and lower pole moieties resulting in a variety of complete or incomplete duplications of the collecting system. Note its isoechogenicity relative to the cortex and the smooth external contour . orientation. 10. They project into the renal sinus, whereas the normal contour of the remaining kidney is maintained. Radiographic features Ultrasound. Definition. Hypertrophied columns of Bertin are isoechoic to slightly hyperechoic compared with adjacent normal renal cortex . 2. Renal hilum: 1. B: CT confirmed a renal lobulation (dromedary hump). These findings help to differentiate it from other pseudomasses such as . Columns of Bertin represent the extension of renal cortical tissue which separates the pyramids and present in ~50% of the healthy population and in 20% are bilateral. Although it may resemble to a mass . Persistent Fetal Lobulations Case Discussion. A mass of homogeneous density contiguous with the . A prospective sonographic analysis of kidneys in 136 adults without clinical or radiologic evidence of renal disease revealed 22 cases of large columns of Bertin. It allows the cortex to be better anchored. Yudin, A. Dromedary hump and Bertini columns are two of the renal pseudotumors. On CT and MRI, columns of Bertin enhance similarly to the adjacent normal renal cortex. A: Ultrasound showing an external bulge on the lateral border of the left kidney, reported as a possible nodule. reported that the incidence of a prominent column of Bertin was 16. It results from hypertrophied cortical tissue. On contrast-enhanced CT and MRI, the enhancement pattern in a column of Bertin should be identical to the renal cortex on all phases—this is most evident on the corticomedullary phase (Fig. renal agenesis. Columns of Bertin is usually lo-cated in the middle third of the kidney, more commonly the left kidney than the right [2]. The renal column (or Bertin column, or column of Bertin) is a medullary extension of the renal cortex in between the renal pyramids. Columns of Bertin is usually located in the middle third of the kidney, more commonly the left kidney than the right . In 1744, French anatomist Exupere Joseph Bertin explained that the renal cortex extended in radial fashion surrounding the renal pyramids. Social and Personal Fears of the Population of UkraineCharacter and Structure in the Sociological Dimension (1992–2021) Liudmyla Kalashnikova et al. 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