Anterior pararenal space

Last revised by Jordan Mackner on 10 Apr 2023

Citation, DOI, disclosures and article data

Citation:

Jones J, Mackner J, Weerakkody Y, et al. Anterior pararenal space. Reference article, Radiopaedia.org (Accessed on 24 Sep 2023) https://doi.org/10.53347/rID-6056

DOI:

https://doi.org/10.53347/rID-6056

Permalink:

https://radiopaedia.org/articles/6056

rID:

6056

Article created:

14 Apr 2009, Jeremy Jones ◉

Disclosures:

At the time the article was created Jeremy Jones had no recorded disclosures.

View Jeremy Jones's current disclosures

Last revised:

10 Apr 2023, Jordan Mackner

Disclosures:

At the time the article was last revised Jordan Mackner had no financial relationships to ineligible companies to disclose.

View Jordan Mackner's current disclosures

Revisions:

29 times, by 11 contributors - see full revision history and disclosures

Systems:

Gastrointestinal, Urogenital

Sections:

Anatomy

Tags:

abdomen, kidney, space

Synonyms:

Anterior pararenal spaces

The anterior pararenal space is the portion of the retroperitoneum that lies between the posterior surface of the parietal peritoneum and the anterior reflection of the renal fascia.

Gross anatomy

It contains the retroperitoneal portion of the duodenum (distal D1 to D3), the pancreas and retroperitoneal segments of the ascending and descending colon. It also contains the roots of the small bowel mesentery and transverse mesocolon¹.

It should be noted that earlier versions of Gray's Anatomy had incorrectly stated the anterior pararenal space to include "the second part...and the fourth part of the duodenum"², and subsequently this has been extensively incorrectly quoted in the literature. This has been updated as of the 42^nd edition as "the second and third portions of the duodenum"¹, however it is widely agreed that the distal portion of the first part is retroperitoneal, which would also logically be included within the space.

Boundaries

medially: there is continuity with the contralateral anterior pararenal space although in most cases, fluid will lateralize to the side of pathology
laterally: the compartment is limited as the lateroconal fascia and parietal peritoneum merge
superiorly: fluid may extend to the dome of the diaphragm immediately posterior to the esophagus and phrenicoesophageal ligament
inferiorly: fluid may extend to the iliac fossa, from there into the pelvis and potentially to the rectus sheath, around the round ligament or ductus deferens and even into the femoral sheath

Radiographic features

There is a paucity of fat within the compartment and therefore, it is difficult to identify on CT or MRI in patients with no additional pathology.

When fluid collects within the anterior pararenal space it becomes easier to identify on CT or MRI. Additionally, because the renal fascia is bilaminated, fluid in the compartment can dissect between the anterior and posterior fascia and sit behind the kidney.

Additionally, fluid can dissect along ligaments and mesenteries to lie in the subperitoneal space, e.g. gastrosplenic ligament, transverse mesocolon and greater omentum.