Crossed fused renal ectopia

Case contributed by Mark Sugi
Diagnosis almost certain


History of HIV and chronic hemolytic anemia with portal vein thrombosis. Presents with concern for abdominal infection.

Patient Data

Age: 60 years
Gender: Male

Contrast-enhanced CT images show inferior crossed fused renal ectopia with fusion of the ectopic left kidney to the inferior right kidney. Both ureters arise anteriorly with the ureter of the right kidney draining into the right ureterovesical junction, and the ureter of the ectopic left kidney draining into the left ureterovesical junction.

Vascular anatomy: The artery supplying the ectopic left kidney arises from the right common iliac artery and there is separate venous drainage of the ectopic left kidney into the inferior vena cava (IVC), medial and inferior to the junction of the right renal vein and IVC.

Multiple non-obstructive renal calculi and cyst in the ectopic left kidney. Prostatomegaly.

Additional findings: cirrhosis of unknown etiology with thrombosis and early cavernous transformation of the main portal vein. Sequela of portal hypertension, including small volume ascites and small esophageal/paraesophageal varices.

Case Discussion

This represents the most common form of crossed fused renal ectopia (type A). This congenital anomaly is often asymptomatic and detected incidentally on imaging performed for other reasons or at antenatal sonography. Symptomatic patients generally present in the setting of vesicoureteral reflux, obstructive renal calculi, or urinary tract infection.

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