Column of Bertin: Kidney Ultrasound, CT, MRI, Hypertrophy & Anatomical Variants

Content:

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

What is Column of Bertin?

The Column of Bertin is a normal anatomical structure in the kidney. It refers to a thickened portion of renal cortical tissue that extends between the renal pyramids, dividing the medullary pyramids. These columns contain nephrons, blood vessels, and connective tissue, functioning just like the surrounding cortical tissue. They are named after the French anatomist Exupère Joseph Bertin, who first described these structures in the 18th century.

Columns of Bertin are important to recognize in imaging studies because they can sometimes mimic renal masses or tumors. Identifying them as normal variants helps avoid unnecessary biopsies or interventions. Typically, these columns are more prominent in adults and can vary in size and thickness depending on the individual.

Kidney Ultrasound

On ultrasound, a Column of Bertin appears as an isoechoic extension of the renal cortex between two pyramids. It blends smoothly with the surrounding cortex and does not distort the overall renal contour. Recognizing this appearance is important, as a prominent column may sometimes be mistaken for a mass, especially if it is hypertrophied or asymmetric.

Doppler ultrasound can help confirm normal vascular flow within the column, further differentiating it from pathological lesions. In most cases, ultrasound is sufficient to identify these columns, particularly when combined with clinical history and other imaging findings.

CT

On CT scans, Columns of Bertin appear as cortical tissue projections extending between the medullary pyramids. They enhance similarly to the surrounding renal cortex after contrast administration. On non-contrast CT, they may appear slightly denser than the medulla, helping radiologists distinguish them from cysts or solid masses.

CT is particularly useful in patients with prominent or hypertrophied columns that may simulate tumors. Recognizing the classic imaging pattern—smooth continuity with cortical tissue and typical vascularization—helps prevent misdiagnosis.

MRI

MRI provides excellent soft tissue contrast, making Columns of Bertin easily identifiable. They appear isointense to the renal cortex on both T1- and T2-weighted images. After gadolinium contrast, these columns enhance similarly to surrounding cortical tissue, confirming their benign nature.

MRI is especially helpful in complex cases where ultrasound or CT findings are inconclusive. It can also differentiate columns from renal tumors, cysts, or scarring, providing high-resolution anatomical detail without ionizing radiation.

Hypertrophy

A hypertrophied Column of Bertin is a column that appears larger than normal. Hypertrophy can occur as a normal variant or as a compensatory response to the absence or underdevelopment of another part of the kidney. While a prominent column may mimic a renal mass on imaging, its typical cortical enhancement pattern and smooth borders help radiologists distinguish it from pathology.

Recognizing hypertrophied columns is essential to avoid unnecessary biopsies or surgical interventions. Clinicians often rely on imaging features, symmetry with the contralateral kidney, and absence of mass effect to confirm a benign variant.

Anatomical Variants

Columns of Bertin demonstrate several anatomical variants. They can vary in size, thickness, and extent of cortical projection. Some individuals may have multiple or prominent columns, while others may have thin or less noticeable ones. These variants are considered normal and do not affect kidney function.

Radiologists must be aware of these variants to prevent confusion with renal tumors, cysts, or other lesions. Proper recognition ensures accurate diagnosis and prevents unnecessary procedures, while understanding the range of anatomical variation allows for confident interpretation of renal imaging studies.