Presentation
Incidental horseshoe kidney on ultrasound.
Patient Data
Age: 25 years
Gender: Male
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Horseshoe kidney is noted.
Both kidneys show small calculi.
Right proximal ureter shows a calculus with upstream hydroureteronephrosis.
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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.
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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