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Horseshoe kidney with accessory renal arteries

Case contributed by Shailaja Muniraj
Diagnosis certain


Incidental horseshoe kidney on ultrasound.

Patient Data

Age: 25 years
Gender: Male

Non contrast CT


Horseshoe kidney is noted.

Both kidneys show small calculi.

Right proximal ureter shows a calculus with upstream hydroureteronephrosis.

Horseshoe kidney is noted with the following details:

  • fusion of the lower poles with formation of a parenchymal isthmus at the level of L2-L3
  • isthmus is seen anterior to the aorta and inferior vena cava and posterior to inferior mesenteric artery
  • both renal pelvises are rotated anteriorly. Ureters also arise anteriorly
  • right distal ureter appears unopacified in the delayed prone images, however, no signs of obstruction noted.

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

Incidental horseshoe kidney identified on ultrasound (not shown) and further evaluated on CT.

Special thanks: Dr. Nanda Kumar

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