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

Non contrast CT

Modality: CT

Horse-shoe kidney is noted

Bilateral kidneys shows small calculi.

Right proximal ureter shows a calculus with upstream hydroureteronephrosis.

Contrast CT

Modality: 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. 

 

 

Renal angiogram

Modality: CT

 

 

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: 15th Dec 2016
System: Urogenital
Inclusion in quiz mode: Included

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