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. They become of radiographic importance when they are unusually enlarged and may be mistaken for a renal mass (renal pseudotumour).
Nomenclature of such enlarged columns is a little confusing, sometimes referred to as septa (although this may also refer to normal columns). Ideally the term hypertrophied column of Bertin or prominent column of Bertin should be used to avoid confusion.
Columns of Bertin are present in ~50% of the healthy population and in 20% are bilateral. Double columns of Bertin in one kidney are less common, occurring in only 4% 5.
Hypertrophied columns of Bertin are more commonly bilateral, occuring in 60% 5.
The kidneys are formed from the fusion of multiple lobules, each containing a central core of medullary tissue surrounded by a mantle of cortex. Fusion of adjacent lobules leads to cortical tissue remaining between the pyramids, each column formed by the fusion of two layers of cortex 2. They are thus located beneath fetal lobulations (usually not visible in adults).
Key to correct identification of a hypertrophied column of Bertin is that fact that it is in continuity with, and of similar appearance to, normal renal cortical parenchyma, and that the renal outline is preserved.
They are usually located in the mid-portion of the kidney and are more commonly found on the left side 4.
Plain film urography
During intravenous urography septa of Bertin may mimic a mass by splaying and distorting the calyces. The renal outline however is normal (which is usually not the case when a renal cell carcinoma is present) and a slight indentation overlying the column may be seen representing location of previous fetal lobulation.
Invariably the diagnosis should be confirmed with CT or MRI.
Appearances on ultrasound can be confusing, however in general the echogenicity of the pseudomass is homogeneous and continuous with renal cortex. The mass has been described as "splitting" or "indenting" the renal sinus.
Often the diagnosis should be confirmed with CT or MRI, or more recently with contrast enhanced sonography, demonstrating similar enhancement as normal cortex.
CT and MRI
CT and MRI are definitive demonstrating the hypertrophied column to have imaging features identical to that of adjacent normal cortex.
On non-contrast CT they appear isodense to normal parenchyma and, following administration of contrast, enhance uniformly with renal cortex, and remain isodense to normal parenchyma on delayed images.
Similarly on MRI they appear isointense to cortex on all sequences and enhance similarly 4.
History and etymology
It is named after Exupere Joseph Bertin, French anatomist who initially described such morphology in renal anatomy in 1744 2-3.
renal cell carcinoma (RCC)
- usually distorts renal outline
- altered vascularity or enhancement
transitional cell carcinoma of the renal pelvis
- usually irregular and infiltrating
- enhances less vividly than cortex on CT and MRI
renal sinus cyst
- does not enhance during nephrogenic phase
- no internal echoes or vascularity
- duplex collecting system with cortical septum
Abdominal and pelvic anatomy
- skeleton of the abdomen and pelvis
- muscles of the abdomen and pelvis
- anterior abdominal wall (surface anatomy)
- posterior abdominal wall
- pelvic floor
- spaces of the abdomen and pelvis
- anterior abdominal wall
- posterior abdominal wall
- peritoneal ligaments
- right supramesocolic space
- left supramesocolic space
- inframesocolic space
- supramesocolic space
- inguinal canal (mnemonic)
- Hesselbach triangle
- scrotal sac
- pelvic cavity
- abdominal and pelvic viscera
- gastro-oesophageal junction
- small intestine
- large intestine
- anal canal
- biliary tree
- adrenal gland
- organs of Zuckerkandl
- renal pelvis
- renal sinus
- avascular plane of Brodel
- urinary bladder
- male reproductive system
female reproductive system
- Mullerian duct
- uterine tubes
- variant anatomy
- gastrointestinal tract
- blood supply of the abdomen and pelvis
- inferior phrenic artery
- coeliac artery
- superior mesenteric artery
- suprarenal artery (middle suprarenal artery)
- renal artery (variant anatomy)
- gonadal artery (ovarian artery | testicular artery)
- inferior mesenteric artery
- lumbar arteries
- median sacral artery
common iliac artery
- external iliac artery
internal iliac artery (mnemonic)
- anterior division
- posterior division (mnemonic)
- variant anatomy
- abdominal aorta
- portal venous system
inferior vena cava
- hepatic veins
- renal vein
- common iliac vein
- variant caval anatomy
- inferior vena cava
- innvervation of the abdomen and pelvis
- lumbar plexus
- lumbosacral trunk
- sciatic nerve
- superior gluteal nerve
- inferior gluteal nerve
- nerve to piriformis
- perforating cutaneous nerve
- posterior femoral cutaneous nerve
- parasympathetic pelvic splanchnic nerves
- pudendal nerve
- nerve to quadratus femoris and inferior gemellus
- nerve to internal obturator and superior gemellus
- 1. Zeman RK, Cronan JJ, Rosenfield AT et-al. Computed tomography of renal masses: pitfalls and anatomic variants. Radiographics. 1986;6 (3): 351-72. Radiographics (abstract) - Pubmed citation
- 2. Lafortune M, Constantin A, Breton G et-al. Sonography of the hypertrophied column of Bertin. AJR Am J Roentgenol. 1986;146 (1): 53-6. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Bertin EJ. Memoire pour servir a I’histoire des reins. In: Histoire de l’Academie Royale des, 1744
- 4. Bhatt S, Maclennan G, Dogra V. Renal pseudotumors. AJR Am J Roentgenol. 2007;188 (5): 1380-7. doi:10.2214/AJR.06.0920 - Pubmed citation
- 5. Radiological Imaging of the Kidney (Medical Radiology / Diagnostic Imaging). Springer. ISBN:B008BBMC8I. Read it at Google Books - Find it at Amazon