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Content:

• What is Column of Bertin?
• Kidney Ultrasound
• CT Imaging
• MRI Imaging
• Hypertrophy
• Anatomical Variants

What is Column of Bertin?

The Column of Bertin is a normal anatomical structure in the kidney where cortical tissue extends between the renal pyramids. It appears as a column of cortical tissue separating the medullary pyramids, typically seen in both kidneys. The column is composed of renal cortex and contains normal vasculature and nephrons, and it serves no pathological function but is important to recognize to avoid misdiagnosis of a renal mass.

It is named after the French anatomist Exupère-Joseph Bertin. The columns can vary in size and sometimes become prominent due to compensatory hypertrophy, especially if one kidney is underdeveloped or diseased. Recognition of these columns is crucial in imaging to differentiate them from renal tumors, cysts, or other pathological lesions.

Kidney Ultrasound

On ultrasound, the Column of Bertin appears as a linear or wedge-shaped cortical projection that extends between the medullary pyramids. It has the same echogenicity as normal renal cortex, making it distinguishable from masses or cystic lesions, which have altered echotexture.

Doppler ultrasound can further confirm the presence of normal blood flow within the column, supporting its benign nature. Ultrasound is often the first imaging modality used to evaluate renal anatomy due to its accessibility and non-invasive nature. Recognizing a Column of Bertin on ultrasound prevents unnecessary biopsies or further imaging.

CT Imaging

On CT scans, the Column of Bertin appears as a continuation of the cortical tissue between renal pyramids. It shows the same attenuation as the surrounding cortex and enhances uniformly with contrast. Unlike renal tumors, it does not form a discrete mass or distort the renal contour.

CT imaging is particularly useful when ultrasound findings are inconclusive or when the kidney’s anatomy needs detailed evaluation. Cross-sectional imaging allows radiologists to differentiate the Column of Bertin from hypertrophied cortical nodules, cysts, or neoplasms, ensuring accurate diagnosis.

MRI Imaging

On MRI, the Column of Bertin demonstrates signal intensity identical to the renal cortex on T1 and T2-weighted sequences. It enhances uniformly after gadolinium administration and follows the normal cortical pattern.

MRI is helpful for patients with contraindications to CT contrast or when high-resolution anatomical detail is required. It is also valuable in complex cases where hypertrophied columns may mimic renal masses. Recognizing the typical appearance prevents misinterpretation and unnecessary interventions.

Hypertrophy

In some cases, the Column of Bertin may become hypertrophied, appearing larger than usual. This hypertrophy can occur due to compensatory mechanisms, such as in cases of contralateral renal agenesis, partial nephrectomy, or chronic renal disease.

Hypertrophied columns are still composed of normal renal cortex and vasculature. Their uniform enhancement and lack of mass effect on imaging help differentiate them from tumors. Awareness of hypertrophy is important for radiologists and clinicians to prevent misdiagnosis.

Anatomical Variants

Columns of Bertin are considered a normal anatomical variant and can vary in size, shape, and symmetry. Some individuals may have prominent columns, while in others they may be subtle or indistinct. Bilateral asymmetry is also possible.

Understanding these variants is essential in renal imaging to distinguish them from pathologic lesions. Knowledge of typical imaging features—such as uniform cortical attenuation or signal, lack of mass effect, and continuity with normal cortex—ensures accurate diagnosis and reduces unnecessary procedures.