HYPERTROPHIED COLUMNS OF BERTIN (also known as “Septa of Bertin”)

Prominent (or hypertrophied) columns of Bertin (also known as “Septa of Bertin”) is the normal variant of the kidney formed of hypertrophied cortical tissue located between the pyramids that projects into the renal sinus, resulting in splaying of the sinus. Hypertrophied but otherwise normal renal tissue not only distorts the renal sinus but can also results in disorganized calyces which can be very well demonstrated on excretory urography and CT urography because the papillae are not situated in the typical radial orientation.

Columns of Bertin are usually located in the middle third of the kidney, more commonly in the left kidney than the right.

1) Indentation on the renal sinus by the lesion.

2) Splitting of the sinus.

3) Well defined and distinct from the renal sinus, in continuity with the adjacent renal cortex with similar echogenicity as that of the adjacent renal cortex.

4) Engulfment of the papilla and cortical projection due to extension of the junctional parenchyma medially in the kidney.

5) A true columns of Bertin appears more echogenic than the normal renal cortex as a result of the anisotropic effect.

 CT Features:
Prominent columns (septa) of Bertin shows enhancement (perfusion) to be similar to that of the surrounding renal parenchyma on CECT

Renal pseudotumors are the masses that are composed of normal or benign renal tissue.

 Types of Renal Pseudotumors
Developmental

Prominent columns (septa) of Bertin

Persistent fetal lobulation

Dromedary hump

Splenorenal fusion

Cross fused renal ectopia

Abscess

Pyelonephritis

Scarred kidney

Xanthogranulomatous  pyelonephritis

Sarcoidosis

Malakoplakia

Tuberculosis

Extramedullary hematopoiesis

Arteriovenous malformation

Renal pelvic hematomas

Anticagulant induced subscapular hemorrhage

Regenerating nodule after reflux