Diagnostic Ultrasound - Abdomen and Pelvis

Column of Bertin, Kidney
Diagnoses: Urinary Tract
TERMINOLOGY
• Hypertrophic band of normal cortical tissue that separate
pyramids of renal medulla
IMAGING
• Isoechoic and continuous with renal cortex, indenting renal
sinus laterally
• Echogenicity may be increased because of anisotropy
• At junction of upper and middle 1/3 of kidney
• Left side > right side
• Extends between renal pyramids
• Normal renal contour
• No vascular distortion with preserved arcuate arteries
surrounding pyramids
• Similar enhancement as normal renal cortex on
corticomedullary and excretory phases on CECT
• Similar signal intensity to renal cortex on T1W, T2W and
contrast-enhanced sequences
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Renal tumor
• Renal scarring
• Renal duplication
• Dromedary hump
PATHOLOGY
• Embryology: Incomplete resorption of polar parenchyma of
subkidneys that fuse to form normal kidney
CLINICAL ISSUES
• Most commonly asymptomatic (presents as imaging
finding)
• Normal variant
• Most likely to simulate mass on sonography
(Left) Graphic shows a column
of Bertin, which is not a real
mass but an extension of renal
cortical tissue between the
pyramids. (Right) Longitudinal
ultrasound of the right kidney
demonstrates a hypertrophied
column of Bertin indenting
the sinus fat in the mid kidney.
Note its isoechogenicity
relative to the cortex and the
smooth external contour .
(Left) Longitudinal ultrasound
of the left kidney
demonstrates a hypertrophied
column of Bertin , which is
isoechoic to renal cortex .
(Right) Enhanced MR of the
same patient (performed for
another renal lesion, not
shown) shows that the lesion
has the same signal
intensity as the renal cortex
, compatible with a
hypertrophied column of
Bertin.
424