Just a normal anatomical variant or something ominous?

This adult male patient has a prominent column of Bertin in the left kidney. 

Can be a cause for alarm if not correctly diagnosed. 

So, what is a hypertrophied column of Bertin?

The column of Bertin is a normal anatomic structure in the kidney that separates the pyramids. It is essentially an extension of the renal cortex and can vary in size between individuals. However, in some cases, it can become hypertrophied, meaning it becomes abnormally enlarged. This can be detected using ultrasound imaging of the kidney.

Further investigations: not needed in most cases as ultrasound imaging is sufficient. 

Important points to remember:

When the column of Bertin becomes hypertrophied, it can present as a mass-like lesion within the renal cortex, which can be easily identified on ultrasound. The size, shape, and location of the hypertrophied column of Bertin can vary, but it is usually located in the middle or upper pole of the kidney.

In the case above, the middle third of the kidney is involved. 

Ultrasound findings:

On ultrasound imaging, a hypertrophied column of Bertin may appear as a well-circumscribed, hypoechoic mass with a smooth surface. It may be seen bulging into the renal pelvis or causing displacement of the renal calyces. It may also be associated with dilatation of the collecting system or renal pelvis.

Color Doppler ultrasound shows normal flow in the region. 

Important differential diagnosis:

However, it is important to differentiate a hypertrophied column of Bertin from other renal masses, such as renal cell carcinoma or oncocytoma. This can be done using additional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI), which can provide more detailed information about the mass, including its vascularity, internal architecture, and signal intensity.

In conclusion, ultrasound imaging can detect a hypertrophied column of Bertin in the left kidney as a mass-like lesion within the renal cortex. Although it is a benign condition, it is important to differentiate it from other renal masses using additional imaging modalities to guide proper management.

For more on this topic visit:

Ultrasound imaging of kidneys