Case Of the Week (COW) 27 July 2014
Answer:
Horseshoe kidney with left distal ureteric calculus.
Findings:
Horseshoe kidney with left distal ureteric calculus causing moderate obstructive left hydroureteronephrosis.
CT Urogram: Significantly delayed nephrogram with no excretion of contrast in the pelvicalyceal system and ureter in the left side due to distal ureteric calculus.
Discussion:
Horseshoe kidney is the most common renal fusion anomaly. It consists of two distinct functioning kidneys lying vertically on either side of the midline, connected at their lower poles by an isthmus of functioning renal parenchyma or, rarely, fibrous tissue that crosses the midline of the body. The isthmus usually lies anterior to the great vessels, at he level of the third to fifth lumbar vertebra, just below the origin of the inferior mesenteric artery from the aorta. The renal axis and orientation of the pelvicalyceal system are abnormal, with the kidney appearing more vertical than normal, the lower poles lying more medial than the upper poles, and the renal pelvises located more anteriorly or laterally than normal Symptoms in Horseshoe kidne are related to hydronephrosis, infection, or calculus formation as in our case. MDCT Urography is very useful to not only diagnose , but to detect complications , vascular supply and assess function of isthumus.
Contributed By:
Dr. Babu Peter, Dr. Srinivasaraman, Dr. Suriya Kumar
Senior Consultant Radiologists, Anderson Diagnostics
Answer:
Horseshoe kidney with left distal ureteric calculus.
Findings:
Horseshoe kidney with left distal ureteric calculus causing moderate obstructive left hydroureteronephrosis.
CT Urogram: Significantly delayed nephrogram with no excretion of contrast in the pelvicalyceal system and ureter in the left side due to distal ureteric calculus.
Discussion:
Horseshoe kidney is the most common renal fusion anomaly. It consists of two distinct functioning kidneys lying vertically on either side of the midline, connected at their lower poles by an isthmus of functioning renal parenchyma or, rarely, fibrous tissue that crosses the midline of the body. The isthmus usually lies anterior to the great vessels, at he level of the third to fifth lumbar vertebra, just below the origin of the inferior mesenteric artery from the aorta. The renal axis and orientation of the pelvicalyceal system are abnormal, with the kidney appearing more vertical than normal, the lower poles lying more medial than the upper poles, and the renal pelvises located more anteriorly or laterally than normal Symptoms in Horseshoe kidne are related to hydronephrosis, infection, or calculus formation as in our case. MDCT Urography is very useful to not only diagnose , but to detect complications , vascular supply and assess function of isthumus.
Contributed By:
Dr. Babu Peter, Dr. Srinivasaraman, Dr. Suriya Kumar
Senior Consultant Radiologists, Anderson Diagnostics