Diaphragm; pelvis
Extraperitoneal fat; great vessels
Anterior pararenal; perirenal, and posterior pararenal

Anatomy of the Retroperitoneum: Area between the posterior portion of
the parietal peritoneum and the posterior abdominal wall muscles.
Extends from the ____ to the ____
Laterally, the boundaries extend to the _____ ___ planes within
the transversalis fascia. Medially, encloses the ___ ___
Subdivided into: ___ ___ space, ____ space, and ____ ____ space

Ascending and transverse

Organs in the Anterior Pararenal Space:
Pancreas Duodenal sweep ___ and ____
colon

Adrenal
Great

Organs in the Perirenal Space:
____ glands Kidneys Ureters
____ vessels

Left; left
Medium

Adrenal Glands:
____ adrenal gland is semilunar in shape and extends along the
medial border of the ___ kidney from the upper pole to the hilus
Internal texture is _____ in consistency; the cortex and medulla
are not distinguished

Size; shape and configuration
Right; right

Adrenal Glands:
Adrenal glands vary in ____, ____ and ____
____ adrenal gland is triangular and caps the upper pole of the
____ kidney

Hypoechoic; echogenic
3-6
3-6
2-4

Adrenal Glands:
Adrenal glad is a distinct _____ structure; sometimes highly
____ fat is seen surrounding the gland
Normal Size:
__ to __ cm long __ to __ mm thick __
to __ cm wide

Larger
1/3; 1/13

Neonatal Adrenal Glands:
Infant adrenal gland is proportionately ____ than the adult
adrenal gland
It is ____ the size of the kidney; in adults, it is ____
the size of the kidney

Thin; thick
Cortex; medulla

Neonatal Adrenal Glands:
Characterized by a ____, echogenic core surrounded by a ___
transonic zone
This thick rim of transoniticity represents the hypertrophied
adrenal ____. Echogenic core is the adrenal _____

Two
Iliac and hypogastric
Paraaortic
Lymphatic

Paraaortic Lymph Nodes:
___ major lymph node bearing areas lie in the retroperitoneal cavity
___ and ____ nodes within the pelvis ____ group
in the upper retroperitoneum
____ chain follows the course of the thoracic aorta, abdominal
aorta, and iliac arteries

Finger
Infected and enlarged

Paraaortic Lymph Nodes:
Normal nodes are smaller than the tip of a ____ (less than 1 cm)
Not normally imaged with ultrasound Can be seen
when ____ and ____

Great vessels

Paraaortic Lymph Nodes: Common sites
Paraarotic and paracaval areas near the ___ ___
Peripancreatic area Renal hilar area
Mesenteric region

Great vessels
Lymphatic

Organs in the Retroperitoneal Space: Posterior Pararenal Space
Lymph nodes
Iliac Fossa
Ureter Major branches of the distal ____
____ ____ vessels

Internal; iliopectineal
False pelvis
Transversalis fascia

Iliac Fossa: The region extending between the ____ surface of the
iliac wings, from the crest to the _____ line
Known as the ___ ____ and contains the ureter, major branches
of the distal great vessels and their lymphatic vessels
____ ____ extends into the iliac fossa at the iliac fascia

Prevesical
Presacral

Pelvic Retroperitoneum: 4 subdivisions -
____ Rectovesical ____
Pararectal (and paravesical) spaces

Rectum
Anteriorly; iliac

Bilateral Pararectal Space:
Bounded laterally by the piriformis and levator ani fascial and
medially by the __
Extends ____ from the bladder, medially to the obturator
internus, and laterally to the external ____ ____

Posterior; posterior
Straight
Common iliac
Anterior

Vascular Supply: Aorta
Enters the abdomen ____ to the diaphragm at the level of L1 and
passes ____ to the left lobe of the liver
Has a ____ horizontal course at the level of L4
Bifurcates into the ____ ____ arteries at level of L4
Slight ____ curve of the aorta as a result of lumbar lordosis

Common iliac; cephalad
Anterior

Vascular Supply: IVC
Extends from the junction of the two ___ ___ veins to the right
of L5 and travels ____
Curves ____ toward its termination into the right atrial cavity

Endocrine
Cortex
Medulla

Physiology of the Retroperitoneum:
Each adrenal gland is made up of two ____ glands
The ____, or outer part, secretes a range of steroid hormones
The ____, or core, secretes epinephrine and norepinephrine

Electrolyte metabolism
Aldosterone
Water content

Physiology of the Retroperitoneum - Cortex: Mineralcorticoids
Regulates ___ ____
____ is the principal mineralcorticoid
Has a regulatory effect on the relative concentrations of
mineral ions in the body fluids and therefore on the ___ ___ of the tissue

Aldosterone
Lowered; acidosis

Physiology of the Retroperitoneum - Cortex: Mineralcorticoids
Insufficient ____ leads to increased excretion of sodium and
chloride ions and water into the urine
Accompanied by a fall in sodium, chloride and bicarbonate
concentrations in the blood, results in a ____ pH or ____

Carbohydrate
Increasing
Cortisone and hydrocortisone
Diminish

Cortex: Glucocorticoids- Responsible for ____ metabolism
Promote deposition of liver glycogen from proteins and inhibit
the use of glucose by the cells, thus ____ the blood sugar level
____ and ____ are primary glucocorticoids
Cortisone and hydrocortisone ____ allergic response, especially
the more serious inflammatory types such as rheumatoid arthritis and
reheumatic fever

Androgens
Estrogens
Adrenal
Minute

Cortex - Sex Hormones: ____ are the male sex hormones
____ are the female sex hormones
___ gland secretion of both androgen and estrogen, regardless
of the patient's gender
Normally secreted in ____ quantities and have almost
insignificant effects

Masculine; prepubertal
Cortex; pituitary; glucocorticoid; increase

Cortex - Sex Hormones: Adrenal tumors in women can promote secondary
____ characteristics. Hypersecretion of the hormone in ____ boys
accelerates adult masculine development and the growth of pubic hair
Adrenal ____ is controlled by adrenocorticotropic hormones
(ACTH) from the ____ gland. Diminished ____ blood concentration
stimulates the secretion of ACTH. Consequent ____ in adrenal cortex
activity inhibits further ACTH secretion

Hypofunction

Cortex - Sex Hormones: Addison's Disease
_____ of the adrenal cortex in humans
Signs and symptoms - hypotension, general weakness, fatigue,
loss of appetite and weight, and bronzing of the skin (hyperpigmentation)

Oversecretion
Hypersecretion

Cortex - Sex Hormones: Adrenal Hyperfunction
_____ from the adrenal cortex may be caused by an overproduction of
ACTH caused by a pituitary tumor, hyperplasia, or a tumor in the
cortex itself
_____ of the cortical hormones produces distinct syndromes:
Cushing's syndrome, Conn's syndrome, and Androgenital syndrome

Sinusoids
Not
Epinephrine and norepinephrine

Medulla: Adrenal Medulla
Makes up the core of the adrenal gland in which groups of irregular
cells are located amid veins that collect blood from the _____
____ essential for life, and can be removed surgically without
causing untreatable damage
Produces _____ and ____

Amines
Heart rate; vasoconstrictor
Glycogenolysis

Medulla: Epinephrine and norepinephrine are ____, sometimes referred
to as catecholamines
They elevate the blood pressure - epinephrine by working as an
accelerator of the ___ ___ and norepinephrine by acting as a _____
The two hormones together promote _____ (breakdown of liver
glycogen to glucose), which causes an increase in blood sugar concentration

Pheochromocytoma

Medulla: Increase in production of medulla hormones may be caused by
a ______, a vascular tumor of the adrenal medulla characterized by
hypersecretion of epinephrine and norepinephrine, causing persistent
or intermittent hypertension.

Size
Rounded

Adrenal Glands: Visualization of the adrenal glands depends on
several factors
___ of the patient Amount of perirenal fat
surrounding the adrenal area Presence of bowel gas
Ability to move the patient into various positions
Adrenal glands should not appear ____, if it does, this finding
suggests a pathologic process

Rounded
Laterally

Paraaortic Lymph Nodes: Sonographic Patterns
____, focal, echo-poor lesions (>1cm) Confluent
echo-poor masses, which often displace the kidney _____

Mantle
Sandwich

Paraaortic Lymph Nodes: May also detect
"____" of nodes in the paraspinal locations
"Floating" or anteriorly displaced aorta, secondary to the
enlarged nodes
Mesenteric "____" sign representing the anterior and
posterior node masses surrounding mesenteric vessels

Aorta and IVC
Supine or decubitus
Left; left

Paraaortic Lymph Nodes: Lymph nodes lie along the lateral and
anterior margins of the ___ and ____
Best image is with the patient in the ___ or ____ position.
___ coronal view using the ___ kidney as a window may be used to
discover paraaortic nodes.

Consistent
Constant
Homogenous
Reproducible

Paraaortic Lymph Nodes: Lymph nodes remain as ______ patterns on sonography.
As gentle pressure is applied with the transducer in an effort to
displace the bowel, the lymph nodes remain _____ in shape.
Echo pattern posterior to each structure is different. Lymph nodes
are _____ and transmit sound easily. Enlarged lymph nodes should be _____.

...

Pathologic Conditions of the Retroperitoneum: Adrenal cortical
syndromes, Adrenal cysts, Adrenal hemorrhage, Adrenal tumors, Adrenal
medulla tumors, Retroperitoneal fat, Primary retroperitoneal tumors,
Secondary retroperitoneal tumors, Retroperitoneal fluid collections,
and Retroperitoneal fibrosis (Ormond�s disease)

Atrophy

Addison's Disease (Adrenocrotical Insufficiency): Affects men and
women equally; not related to age
_____ of the adrenal cortex occurs with decreased production of
cortisol and sometimes aldosterone. Majority of the cortical tissue is
often destroyed before adrenal insufficiency is diagnosed.
Primary causes of reduced adrenal cortical tissue: Autoimmune
process, Tuberculosis (TB), Inflammatory process, Primary neoplasm and Metastases