Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS.

For personal use only; all rights reserved

Perspective
The Great Escape: Interfascial Decompression Planes of the
Retroperitoneum
Richard M. Gore 1, Dennis M. Balfe 2, Robert I. Aizenstein 3, Paul M. Silverman 4

R etroperitoneal fluid collections re-
sult from a variety of infectious,
neoplastic, inflammatory, and trau-
matic causes. In most instances, these fluid
collections remain in their compartment of ori-
gin confined by the anterior and posterior renal
fascia, lateroconal fascia, adhesions, or inflam-
matory closure of potential outlets [1, 2]. How-
ever, when large volumes of fluid develop
rapidly, the capacity of the retroperitoneal
space of origin to accommodate the fluid may
be overwhelmed, often causing the recruit-
ment of laminated, variably fused, and poten-
tial expansile retroperitoneal fascial planes for
decompression [3–5]. These fascial planes also
serve as a conduit for the spread of fluid, in-
flammation, and tumor. This perspective ana-
lyzes recent concepts concerning the origin,
location, nature, and significance of fascial
planes and their ability to serve as spaces that
can decompress retroperitoneal fluid collec-
tions and infiltrating diseases.
Embryologic Considerations
An understanding of the distribution of
fluid in the retroperitoneum is contingent on
an appreciation of the fact that the retroperi-
toneum forms in layers and that the retroperi-
toneal fascia is composed of multiple discrete
layers representing fused leaves of apposed
embryonic mesentery [6–8] (Fig. 1 and Ap-
pendix). The primary body wall, which is the
outermost layer of the embryo, is formed by
mesenchyme, which develops in the vertebral
bodies, paraspinal muscles, and the psoas
muscle. The body wall is lined with transver-
salis fascia, which forms the outer border of
the retroperitoneal and peritoneal cavities.
Deep in relation to the transversalis fascia lies
a variable amount of properitoneal fat that
forms the posterior pararenal space. This
small, almost unoccupied space is seldom the
primary site of abnormality. Two fat pads ex-
ist in this space: one lies posterolateral and
one directly ventral to the quadratus lumbo-
rum muscle [9].
The kidneys form in the pelvis in early em-
bryologic life and then ascend to their adult
position. As a result, the fascia that surrounds
each kidney forms a long tapered cone that
fuses at its posterior and lateral aspects to the
surface of the properitoneal fat. At this point of
development, two defined retroperitoneal
spaces exist: the perirenal space, which con-
tains the kidneys, adrenal glands, proximal
ureters, and fat; and the posterior pararenal
space, which contains only fat. A potential
space is also created between these fused sur-
faces, the posterior interfascial or retrorenal
plane [10, 11]. This potential space may be re-
cruited for the decompression of fluid collec-
tions arising in either of the spaces it bounds.
The perinephric space is divided by thin
fibrous lamellae (Fig. 2) into multiple com-
partments that may or may not communicate
[12]. These fibrous lamellae also form bridg-
ing septa that traverse the perinephric fat and
interconnect the renal capsule and anterior
and posterior renal fasciae. These bridging
septa are continuous with the anterior and
posterior interfascial planes and may serve as
a bidirectional conduit for the spread of
blood, fluid, edema, and infiltrating soft tis-
sue from the perirenal interfascial planes into
the perinephric space.
The next embryologic development key to
this discussion is the rotation and subsequent
fusion of the gut and its dorsal mesentery. In
this complex process, the mesentery, which
contains the pancreas and duodenum, rotates
and fuses. Under the influence of the rapidly
growing liver, the stomach and duodenum are
rotated counterclockwise, so that the left side
of this mesentery becomes anterior. The right
side of the mesentery becomes closely ap-
posed to the body wall, aorta, inferior vena
cava, and anterior part of the right renal fascia.
In fusing, the dorsal mesoduodenum forms the
pancreaticoduodenal space, creating another

Received December 9, 1999; accepted after revision January 24, 2000.

1
Department of Radiology, Evanston Hospital–Northwestern University, 2650 Ridge Ave., Evanston, IL 60201. Address correspondence to R. M. Gore.
2
Department of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO 63110.
3
Department of Radiology, University of Illinois Medical Center, 1740 W. Taylor, Chicago, IL 60612.
4
Department of Radiology, M. D. Anderson Cancer Center, Department of Radiology, Box 057, 1515 Holcomb Blvd., Houston, TX 77030.
AJR 2000;175:363–370 0361–803X/00/1752–363 © American Roentgen Ray Society

AJR:175, August 2000 363

 Fig. 1.—Retroperitoneal
Gore et al. and interfascial planes. Drawing at level of renal hila shows that
renal and lateroconal fasciae are laminated planes composed of apposed layers of embry-
onic mesentery. Thickness of interfascial planes is exaggerated to illustrate their poten-
tially expansile nature. Note that perinephric spaces (PRS) are closed medially.
Retromesenteric space is continuous across midline. Retromesenteric anterior interfas-
cial space (RMP), retrorenal posterior interfascial space (RRS), and lateroconal plane
communicate at fascial trifurcation (arrows). A = aorta, APS = anterior pararenal space,
ARF = anterior renal fascia, DPS = dorsal pleural sinus, IVC = inferior vena cava, LCF = lat-
eroconal fascia, PP = parietal peritoneum, PPS = posterior pararenal space, PRF = poste-
rior renal fascia, TF = transversalis fascia, asterisk = posterior peritoneal recess.
(Reprinted from [3])
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved

A B

Fig. 2.—Perinephric space bridging septa.

A, Drawing of perinephric space at level of mid pole of kidney shows that perinephric space contains rich
network of bridging septa (open arrows), lymphatics (solid arrow), arteries, and veins (arrowhead). Note
that perirenal lymphatics communicate with small lymph nodes at renal hilum, and that these, in turn, con-
nect with periaortic and pericaval lymph nodes. This lymphatic network provides potential route of spread
for metastatic tumor into perinephric space. (Reprinted from [3])
B and C, T1-weighted (B) and T2-weighted fat-suppressed (C) MR images in 47-year-old man with left-sided
pyelonephritis reveal fluid-filled bridging perinephric septa (arrows).
C

potential space between the fused surfaces of
these fat-containing structures—an anterior in-
terfascial or retromesenteric plane.
Pari passu, the colon and its mesentery un-
dergo complex rotation and fusion to form
the lateral portions of the anterior pararenal
space. The mesentery of the descending co-
lon rotates in a clockwise direction (as
viewed from below) and its left lateral sur-
face fuses with the anterior renal fascia. Lat-
eral in relation to the anterior renal fascia,
the dorsal mesocolon fuses with the surface
of the posterior pararenal fat to form the lat-
eroconal fascia. The ascending colon and its
mesentery undergo a 180º counterclockwise

364 AJR:175, August 2000

 Interfascial Decompression Planes of the Retroperitoneum
rotation (as viewed from the front) so that its
original left surface faces right. The mesen-
tery of the ascending colon rotates counter-
clockwise (as viewed from below) to fuse
with the anterior renal fascia (proximally, be-
low the transverse duodenum) and distally to
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved
fuse with the pancreaticoduodenal space.
The lateral part of the right colon fuses with
the properitoneal fat to form the lateroconal
fascia. These retromesenteric fusion planes
create a potential space (the anterior interfas-
cial plane) that lies ventral in relation to the
anterior renal fascia and dorsal in relation to
the mesenteries of the ascending and de-
scending colons.
Anatomic Considerations
The existence of the interfascial retroperi-
toneal planes was recently documented in a
series of cadaveric dissections by Molmenti
et al. [5]. In that study, latex injected into the
tail of the pancreas entered an anterior inter-
fascial retromesenteric plane that was dorsal
in relation to the anterior pararenal space
and ventral in relation to the anterior renal
fascia. The plane continued superiorly in re-
lation to the diaphragm near the esophageal
hiatus; inferiorly in relation to the pelvis
along the anterolateral surface of the psoas
muscle; and laterally, posteriorly in relation
to the descending colon and its mesentery.
This anterior interfascial retromesenteric
plane also communicated with the posterior
interfascial retrorenal plane lying between
the posterior renal fascia and the posterior
pararenal space.
The laminated anterior interfascial ret-
romesenteric plane is continuous across the
midline, and it communicates at the fascial
trifurcation (Fig. 3) with the two other po-
tentially expansile planes, the posterior in-
terfascial and lateroconal planes.
In the iliac fossa, the anterior and posterior
renal fascia fuse to form a single multilaminar
fascia, the combined interfascial plane. This
combined interfascial plane continues in the
pelvis along the anterolateral margins of the
psoas muscle contiguous with the pelvic retro-
peritoneal perivesical and presacral spaces.
Therefore, this plane can serve as a decom-
pressing conduit to the pelvis for interfascial
fluid originating in the retroperitoneum. The
inferior blending of Gerota’s fascia also seals
the inferior aspect of the perinephric space.
This prevents the extension of perinephric
fluid from the abdominal retroperitoneum into
the pelvis. Because the retroperitoneal fascial
planes traverse the midline and are continuous
AJR:175, August 2000
with the pelvic retroperitoneum, interfascial
fluid collections can spread from the abdomi-
nal retroperitoneum across the midline or into
the pelvis.
The concept of recruitable planes sur-
rounding the renal fascia can help resolve
several conflicting, recently published ca-
daver studies that have investigated the ex-
tension of retroperitoneal fluid into the pelvis
and across midline. Mindell et al. [13],
Kneeland et al. [14], and Mastromatteo et al.
[15] have concluded that the cone of the re-
nal fascia is open, allowing fluid to extend
across the midline and into the pelvis [16]. In
two different studies, Raptopoulos et al. [17,
18] used latex injections of subsequently dis-
sected cadavers and concluded that the cone
of renal fascia is closed, preventing fluid
from crossing the midline and extending into
the pelvis. The interfascial plane concept ac-
knowledges that although the renal fascia do
indeed form an enclosed space, fluid can leak
through bridging perinephric septa [12] and
extend into the interfascial planes. From
there, the fascia can descend into the pelvis
via the combined interfascial plane and cross
the midline via the anterior interfascial ret-
romesenteric plane.
Clinical and Imaging Observations
The concept that the previously described
lines of fusion are expandable planes in which
Fig. 3.—52-year-old woman with aortic bleeding. CT scan at level of lower poles of kidneys shows hemorrhage
in anterior interfascial plane (straight open arrow), posterior interfascial plane (curved solid arrow), and latero-
conal interfascial plane (curved open arrow). These collections meet at fascial trifurcation (straight solid arrow).
rapidly growing fluid collections may accu-
mulate is also supported by clinical and imag-
ing observations.
Surgical Anatomy
When performing a right or left hemi-
colectomy, the surgeon mobilizes the as-
cending and descending colons by dissecting
through the anterior and lateroconal fusion
planes beginning at the “white line of Toldt”
[19]. This dissection is usually quite easy,
nearly bloodless, and does not compromise
the viability of the bowel, allowing the as-
cending and descending colons to be mobi-
lized freely. Similarly, when transabdominal
surgical exposure of either kidney or ureter is
required, the procedure is facilitated by the
medial reflection of the overlying colon.
Again, this task is readily accomplished
without the need for sharp dissection. How-
ever, these dissecting planes may be difficult
to develop in patients with a history of pan-
creatitis [20].
Anatomic Variants
The site of fusion between the anterior and
posterior laminae of the posterior renal fascia
normally is lateral in relation to the kidney. If
this fusion occurs more dorsally than usual,
then fluid in the posterior sulcus of the perito-
neal cavity can reside in the posterior interfas-
cial retrorenal plane (Fig. 4). Additionally,
peritoneal fluid can accumulate in the anterior
365
 Gore et al.

interfascial retromesenteric planes in patients
in whom the mesenteries of the ascending and
descending colons have not completely fused
(Fig. 4) to the retroperitoneum.
Pancreatitis
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved
pararenal space, lesser sac, and subperitoneal
spaces of the small bowel mesentery and trans-
verse mesocolon. In some individuals, fluid
and inflammatory tissue may accumulate in
the retroperitoneal interfascial planes, dissect-
ing posteriorly (Fig. 5) to involve the posterior
teric plane (Fig. 6), or spreading inferiorly in
the combined interfascial plane to reach the
pelvic retroperitoneum or superiorly along the
diaphragm to enter the mediastinum.
Perirenal fluid collections related to pan-
creatitis can access the posterior interfascial

In patients with pancreatitis, inflammatory interfascial retrorenal plane, traversing the plane and extend into the transversalis fascia
fluid most commonly extends into the anterior midline in the anterior interfascial retromesen- through a cleft between the medial border of

Fig. 4.—59-year-old man with fulminant ulcerative

colitis in whom incomplete fusion of fascial planes has
permitted retromesenteric and retrorenal extension of
peritoneal fluid. CT scan shows that ascending (A) and
descending (D) mesocolons have not completely
fused with renal fascia, permitting ascites (straight ar-
rows) to enter anterior interfascial retromesenteric
plane. Posterior renal fascia has also not fused, allow-
ing peritoneal fluid to extend into retrorenal posterior
interfascial planes (curved arrows). These anterior in-
terfascial planes are easily surgically dissected dur-
ing hemicolectomy. Posterior interfascial planes are
readily dissected during nephrectomy.

Fig. 5.—45-year-old woman with interfascial fluid spread in acute pancreatitis
and retrorenal dissection of fluid in lumbar triangle. Note fluid in left anterior in-
terfascial space (straight open arrow), lateroconal interfascial space (curved
open arrow), and posterior interfascial space (curved solid arrow). Fluid ex-
tends to and thickens transversalis fascia (straight solid arrow), dissecting
quadratus lumborum muscles and posterior pararenal fat (arrowhead). This is
source of Grey Turner’s sign of pancreatitis.
Fig. 6.—58-year-old man with pancreatitis and inflammatory fluid spread into interfas-
cial planes. CT scan shows fluid extending into anterior interfascial space (open
arrow), right fascial trifurcation (solid arrow), and subsequently lateroconal and pos-
terior interfascial spaces. Note that fat in anterior pararenal space adjacent to as-
cending colon (AC) is spared.

366 AJR:175, August 2000

 Interfascial Decompression Planes of the Retroperitoneum

the posterior pararenal space and the lateral
border of the quadratus lumborum fat pad,
the lumbar triangle. The relatively low posi-
tion of flank discoloration associated with
pancreatitis (Grey Turner’s sign) is attribut-
able to this lumbar triangle pathway.
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved
planes and from there, spread into the peri-
nephric space [12].
Urinomas
Encapsulated collections of urine that lie
outside the renal collecting system and ureters
9) are the major causes of duodenal perfora-
tion and the pathologic gas and fluid that
may decompress into the anterior interfascial
space. Extravasated gas, bile, and pancreatic
juice may extend into the pancreaticoduode-
nal space and subsequently cross the midline

Perirenal Hematomas
Subcapsular and perinephric hematomas re-
sult from a number of traumatic (biopsy, lithot-
ripsy, or blunt abdominal injury) and
neoplastic (renal cell carcinoma or angiomyo-
lipoma) causes [21]. The hematomas can gain
access to the anterior and posterior interfas-
cial planes via numerous bridging peri-
nephric septa that consist of fibrous lamellae,
which traverse the perirenal space (Fig. 7).
Conversely, these septa may be a conduit of
hemorrhage or other rapidly accumulating
fluid collections that recruit the interfascial
most commonly result from obstructive uropa-
thy and less frequently from abdominal
trauma, surgery, or diagnostic instrumentation
[22]. Most urinomas reside in the perinephric
space. This fluid can access the interfascial
planes via the bridging perinephric septa or by
direct extension occurring with ureteral disrup-
tion. Disruption of the ureteropelvic junction
characteristically fills both the anterior and
posterior interfascial planes [23–25] (Fig. 8).
Duodenal Perforation and Pneumoretroperitoneum
Blunt abdominal trauma, peptic ulcer dis-
ease, and endoscopic sphincterotomy (Fig.
via the anterior interfascial retromesenteric
plane. Similar to retroperitoneal fluid, retro-
peritoneal gas readily dissects preestablished
interfascial planes (Fig. 10).
Colonic Diseases
As previously stated, the ascending and
descending mesocolons fuse posteriorly with
the anterior renal fascia and laterally with the
anterior surface of the posterior pararenal fat.
Accordingly, the laminated lateroconal and
anterior interfascial planes partly comprise
variably fused layers of mesocolon that have
become retroperitoneal. Because the anterior

A B

Fig. 7.—65-year-old man with spontaneous subcapsular renal hemorrhage de-

compressing along perinephric bridging septa and retroperitoneal interfascial
planes.
A, CT scan at level of mid kidney shows both subcapsular and perinephric hem-
orrhage. Note thickened perinephric bridging septa (arrows).
B, CT scan at level slightly lower than that of A shows perinephric blood decom-
pressing in anterior (open arrow) and posterior (curved arrow) interfascial
planes. Note that descending colon (straight solid arrow) and fat in anterior
pararenal space are uninvolved.
C, CT scan at level of iliac crest shows that blood extending down anterior and
posterior interfascial planes lies in caudal continuation of these structures—the
combined interfascial plane (arrows).
C

AJR:175, August 2000 367

 interfascial and lateroconal planes are so inti-
mately associated with the retroperitoneal-
ized ascending and descending mesocolons,
the edema and inflammation associated with
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved
diverticulitis, ischemic
Gore et(Fig.
al. 11) and infec- Abdominal Aortic Aneurysm Rupture
tious (Fig. 12) colitis, retrocecal appendici- Hemorrhage caused by abdominal aortic
tis, and infiltrating colonic neoplasms can aneurysm rupture or disruption of the inferior
spread into the interfascial planes. vena cava can communicate with the retro-

Fig. 8.—Ruptured calyceal fornix with urine decompressing into ante- Fig. 9.—Interfascial dissection of gas. CT scan shows ERCP-related duodenal perforation re-
rior and posterior (curved arrow) interfascial spaces in 60-year-old sulting in dissection of gas in anterior interfascial plane (straight arrow) in 63-year-old man.
woman with obstructive uropathy caused by adenopathy resulting from Scan also shows gas and fluid in posterior interfascial plane (curved arrow).
stage IV cervical cancer. CT scan at level of mid pole of right kidney
shows hydronephrosis and urine dissecting into bridging perinephric
septa. Multiple calcified gallstones are present. Note posterior peri-
nephric (Zuckerkandl’s body) fascia (straight arrow) is separated from
posterior pararenal space by this urinoma.

Fig. 10.—Intraperitoneal and retroperitoneal gas is present on this CT scan of 61-year-
old man with chronic obstructive pulmonary disease, pneumothorax, and retroperito-
neal and peritoneal extension of air. Note how gas has easily dissected anterior
(straight arrow) and posterior (curved arrow) interfascial planes. Intramural dissec-
tion of gas has also occurred in colon.
Fig. 11.—CT scan of 57-year-old man with schemic colitis shows edema extending into an-
terior interfascial plane (open arrow), fascial trifurcation (solid arrow), and pericolic fat in
anterior pararenal space. Note marked colonic mural thickening and submucosal edema.

368 AJR:175, August 2000

 Interfascial Decompression Planes of the Retroperitoneum

peritoneum via a number of pathways [26].
Most abdominal aortic aneurysms bleed pos-
teriorly and are confined by the psoas space
or extend into the posterior interfascial plane
behind the left kidney. The inferior vena cava
often bleeds directly into the right posterior
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved
present as a groin mass or in the anterior in-
terfascial plane to cause obstructive jaundice
or duodenal or colonic obstruction [27].
Metastatic Disease
Metastatic tumors can spread to the peri-
the perinephric space that may subsequently in-
volve the interfascial planes [28].
Summary
In this perspective, we have presented em-

interfascial plane [26]. Hemorrhage is often
present in one or both perirenal spaces as
well. The anterior interfascial planes are less
commonly involved (Fig. 13). These obser-
vations suggest that the abdominal aorta and
inferior vena cava may be continuous with or
actually reside in the medial aspect of the
posterior interfascial plane.
Aortic hemorrhage can also dissect the
pelvis in the combined interfascial plane and
nephric spaces and interfascial planes by several
mechanisms. Most commonly, paraaortic and
pericaval retroperitoneal lymph nodes commu-
nicate with small lymph nodes near the renal si-
nus, and these, in turn, connect with small
lymph nodes and a rich network of lymphatics
in the perinephric space [1] (Fig. 14). Pleural
and transdiaphragmatic lymphatics communi-
cate with the superior aspect of the perinephric
space, providing a pathway of disease spread to
bryologic, anatomic, clinical, and imaging
evidence that fluid collections originating in
a retroperitoneal space may exit the space by
entering easily dissectable planes that result
from the embryologic fusion of dorsal me-
senteries. These planes extend from the dia-
phragm to the pelvic floor and appear to be
an important means by which rapid accumu-
lating fluid collections and infiltrating dis-
eases extend into the retroperitoneum.

Fig. 12.—CT scan of 49-year-old man with pseudomembranous colitis shows mural thick-
ening of ascending (AC) and descending (DC) colons. Note inflammation of fat of anterior
pararenal spaces bilaterally. Also note that fluid has extended in anterior (straight arrow)
and posterior (curved arrows) interfascial spaces bilaterally.
Fig. 13.—Aortic aneurysm rupture with interfascial spread of retroperitoneal
hematoma (straight arrows) in 73-year-old man. CT scan obtained at level of
lower pole of left kidney reveals hyperdense hematoma extending across mid-
line in anterior interfascial (retromesenteric) plane bilaterally. On right, he-
matoma also decompresses in posterior interfascial plane (curved arrow).

Fig. 14.—Metastases to perinephric and interfascial spaces from carcinoma of pancreas

in 70-year-old woman. CT scan shows marked retroperitoneal lymphadenopathy (curved
arrow) with tumor spread into anterior interfascial plane (open arrow). Tumor has also in-
filtrated perinephric lymphatics (straight solid arrow).

AJR:175, August 2000 369

 Gore et al.

References
1. Meyers MA. Dynamic radiology of the abdomen:
normal and pathologic anatomy, 4th ed. New
York: Springer, 1994
2. Chesbrough RM, Burkhard TK, Martinez AJ,
Burks DD. Gerota versus Zuckerkandl: the renal
fascia revisited. Radiology 1989;173:845–846
Downloaded from www.ajronline.org by 89.130.189.147 on 03/15/18 from IP address 89.130.189.147. Copyright ARRS. For personal use only; all rights reserved
Philadelphia: Lippincott-Raven, 1998:585–618
10. Dodds WJ, Darweesh RMA, Lawson TL, et al.
The retroperitoneal space revisited. AJR 1986;
147:1155–1161
11. Raptopoulos V, Lei QF, Touliopoulos P, Vrachliotis
TG, Marks SC Jr. Why perirenal disease does not ex-
tend into the pelvis: the importance of closure of the
Silverman P. Renal fascial pathway: posterior exten-
sion of pancreatic effusions within the anterior parare-
nal space. Radiology 1986;158:367–374
19. Condon RE. Resection of the colon. In: Zuidema
GA, ed. Schackelford’s surgery of the alimentary
tract, 4th ed. Philadelphia: Saunders, 1995:207–236
20. Hinman F Jr. Atlas of urological anatomy. Phila-

3. Aizenstein RI, Wilbur AC, O’Neal HK. Interfas-
cial and perinephric pathways in the spread of ret-
roperitoneal disease: refined concepts based on
CT observations. AJR 1997;168:639–643
4. Aizenstein RI, Owens C, Sabniss S, Wilbur AC,
Hibbeln JF, O’Neil HK. The perinephric space
and renal fascia: review of normal anatomy, pa-
thology, and pathways of disease spread. Crit Rev
Diagn Imaging 1997;36:325–367
5. Molmenti EP, Balfe DM, Kanterman RY, Bennett
HF. Anatomy of the retroperitoneum: observation
of the distribution of pathologic fluid collections.
Radiology 1996;200:95–103
6. Wagner M, Lawson TL. Segmental anatomy: ap-
plication to clinical medicine. New York: Mac-
Millan, 1982
7. Hureau J, Acossou-Voyeme AK, Germain M, Pradel J.
Les espaces interpariétonéaux postérieurs ou espaces
rétropéritonéaux. I. Anatomia topographique normale.
Eur J Radiol 1991;72:101–116
8. Hureau J, Agossou-Voyeme AK, Germain M, Pradel J.
Les espaces interpariétonéaux postérieurs ou espaces
rétropéritonéaux. II. Anatomia tomodensitomé trique
pathalogique. Eur J Radiol 1991;72:205–227
9. Balfe DM. Normal abdominal and pelvic anatomy. In:
Lee JKT, Sagel SS, Stanley RJ, Heiken JP, eds. Com-
puted body tomography with MRI correlation, 3rd ed.
cone of renal fasciae. AJR 1995;164:1179–1184
12. Kunin M. Bridging septa of the perinephric
space: anatomic, pathologic, and diagnostic con-
siderations. Radiology 1986;158:361–365
13. Mindell HJ, Mastromatteo JF, Dickey KW, et al.
Anatomic communications between the three retro-
peritoneal spaces: determination by CT-guided in-
jection of contrast material in cadavers. AJR 1995;
164:1173–1178
14. Kneeland JB, Auh YH, Rubenstein WA, et al. Peri-
renal spaces: CT evidence for communication
along the midline. Radiology 1987;164:657–664
15. Mastromatteo JF, Mindell HJ, Mastromatteo MF,
Magnant MB, Sturtevant NV, Shuman WP. Com-
munications of the pelvic extraperitoneal spaces:
helical CT cadaver study with pelvic extraperito-
neal injections. Radiology 1997;202:523–530
16. Beaulieu CF, Mindelzun RE, Dolph J, Jeffrey RB
Jr. The infraconal compartment: a multidirec-
tional pathway for the spread of disease between
the extraperitoneal abdomen and pelvis. J Com-
put Assist Tomogr 1997;21:223–228
17. Raptopoulos V, Touliopoulos P, Lei QF, Vrachliotis
TG, Marks SC Jr. Medial border of the perirenal
space: CT and anatomic correlation. Radiology
1997;205:777–784
18. Raptopoulos V, Kleinman PK, Marks SC Jr, Snyder M,
delphia: Saunders, 1993:257–268
21. Yip KTL, Peh WLG, Tam PC. Spontaneous rupture
of renal tumours: the role of imaging in diagnosis
and management. Br J Radiol 1998;71:146–154
22. Kawashima A, Sandler CM, Corriere JN Jr, Rodgers
BM, Goldman SM. Ureteropelvic junction injuries
secondary to blunt abdominal trauma. Radiology
1997;205:487–492
23. Lei QF, Marks SC Jr, Touliopoulos P, Raptopou-
los V. Fascial planes and compartments of the
posterior abdomen: the perirenal and pararenal
pathways. Clin Anat 1990;3:1–15
24. Korobkin M, Silverman PM, Quint LE, Francis IR.
CT of the extraperitoneal space: normal anatomy
and fluid collections. AJR 1992;159:933–941
25. Rosen A, Korobkin M, Silverman PM, Moor AJ
Jr, Dunnick NR. CT diagnosis of ruptured aortic
aneurysms. AJR 1984;143:262–268
26. Parke CE, Stanley RJ, Berlin AJ. Infrarenal vena
caval injury following blunt trauma: CT findings.
J Comput Assist Tomogr 1993;17:154–157
27. Politoske EJ. Ruptured abdominal aortic aneu-
rysm presenting as an obstruction of the left co-
lon. Am J Gastroenterol 1990;85:745–747
28. Wilbur AC, Turk JN, Capek V. Perirenal metastases
from lung cancer: CT diagnosis. J Comput Assist
Tomogr 1990;85:745–747

APPENDIX: Terms and Definitions

Interfascial plane: Potential space between layers of renal, lateroconal, or transversalis fascia; result of fusion of embryonic mesentery.
Anterior interfascial retromesenteric plane: Potentially expansile plane between the anterior pararenal and perinephric spaces; continu-
ous across the midline, it is an important potential route of contralateral spread of retroperitoneal collections.
Posterior interfascial retrorenal plane: Potentially expansile plane between the perinephric space and posterior pararenal space; anterior
pararenal, peritoneal, or intrafascial fluid may reside within the retrorenal space.
Lateroconal interfascial plane: Potentially expansile plane between layers of lateroconal fascia; communicates with anterior and posterior
interfascial planes at the fascial trifurcation.
Combined interfascial plane: Potentially expansile plane formed by the inferior blending of the anterior renal, posterior renal, and latero-
conal fasciae; continues into the pelvis, providing a route of disease spread from the abdominal retroperitoneum into the pelvis.
Fascial trifurcation: Site at which the lateroconal fascia emerges from Gerota’s fascia; anterior, posterior, and lateroconal interfascial
planes communicate at the fascial trifurcation, usually located laterally to the kidney.

370 AJR:175, August 2000