Hypertrophic column of Bertin
The renal column of Bertin is a medullary extension of the renal cortex in between the renal pyramids. Hypertrophic column of Bertin (HCB) is a normal variant that appears as a mass that extends towards renal sinus.
How to differentiate it from a real renal mass?
| HCB | Renal tumor |
| 1. Usually isoechoic with rest of the cortex | Can be isoechoic or heterogeneous but usually demarcates itself from the renal parenchyma. May contain calcifications or necrotic areas. |
| 2. Protrudes inwards into the sinus fat and the renal outline is preserved | Grows outwards and usually distorts the renal outline |
| 3. On Doppler, the vascular pattern is similar to that of the surrounding renal parenchyma. Use power Doppler for better identification of flow. | The vasculature is prominent in the periphery of the mass |
| 4. May wrap around the medullary pyramid without distorting its architecture | Distinct from pyramid, may compress |
Some HCBs may demonstrate atypical characteristics on greyscale ultrasound and may need contrast-enhanced CT/MRI/ultrasound to make sure it is similar to adjacent cortical tissue.
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