Horseshoe kidney with bilateral renal stones and hydronephrosis

Case contributed by Mostafa Elfeky
Diagnosis almost certain


Abdominal pain.

Patient Data

Age: 45 years
Gender: Male

Horseshoe kidney with bilateral renal stones and hydronephrosis. Upper part of the left ureter is obstructed by a small calculus. Right ureter is average in caliber with no stones. Small left renal simple cyst. Small renal parenchymal hypoenhancing lesion is seen in the left side of the isthmus with foci of calcifications.

Homogeneous decreased liver density sparing gallbladder bed, reflecting diffuse fatty infiltration with focal fatty sparing. Few splenic subcapsular simple cysts at its lower pole.

Case Discussion

Horseshoe kidney remains asymptomatic until incidentally discovered or develops complications. The patient presented with two common complications of horseshoe kidney, renal stones and hydronephrosis. Their incidence is around 60% of cases.

Hydronephrosis in horseshoe kidney may be due to ureterolithiasis or pelviureteric junction obstruction, secondary to recurrent urinary tract infection, high insertion of ureters into renal pelvises, anomalous renal blood supply and abnormal course of the ureters anterior to the isthmus 1-3.

CT is the modality of choice for detecting renal tumors, which are reported to have increased incidence in horseshoe kidneys with predilection to affect isthmus 5.

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