Horseshoe kidney with accessory renal arteries

Case contributed by Dr Shailaja Muniraju

Presentation

Incidental horse-shoe kidney on ultrasound.

Patient Data

Age: 25 years
Gender: Male
CT

Non contrast CT

Horse-shoe kidney is noted

Bilateral kidneys shows small calculi.

Right proximal ureter shows a calculus with upstream hydroureteronephrosis.

CT

Contrast CT

Horse-shoe kidney noted with the following details:

- There is fusion of the bilateral lower poles with formation of isthmus at the level of L2-3.

- The isthmus is seen anterior to aorta and inferior venacava and posterior to inferior  mesenteric      artery.

- The bilateral renal pelvis is rotated anteriorly. Ureter also arises anteriorly.

- The right distal ureter appears unopacified in the delayed –  prone images, however no signs of obstruction noted. 

 

 

CT

Renal angiogram

 

 

The right main renal artery arises at L2 level.

The left main renal artery arises at L3 level.

The isthmus is supplied by a single artery arising, directly from aorta.

Multiple accessory renal arteries are seen to arise from the aorta as follows:

  •  Right accessory polar artery 1 – arises at D12 level and supplies upper pole.
  •  Right accessory hilar artery 2 – arises at L3 level and supplies hilum.
  •  Left accessory polar artery 1 – arises at L1 level and supplies upper pole.
  •  Left accessory polar artery 2 – arises at L2 level and supplies mid pole.
  •  Left accessory polar artery 3 – arises at L5 level and supplies lower pole.

Case Discussion

This is a case of horse-shoe kidney.

Special thanks: Dr.Nanda kumar

 

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Case information

rID: 49920
Case created: 9th Dec 2016
Last edited: 30th May 2017
System: Urogenital
Inclusion in quiz mode: Included

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