Presentation
Primary infertility.
Patient Data
Single renal mass lying at the level of L2 vertebral body till L4-5 disc space. It has double renal arteries, one from the ventral aspect of the abdominal aorta just before its bifurcation at L3-4 disc level and the other one from the left common iliac artery.
Two pelvicalyceal systems and two ureters are noted.
Right scrotal sac is empty. The right testis is seen intra-abdominal in right iliac fossa under the anterior abdominal wall. It shows a normal signal pattern with no focal lesion. It shows high signal intensity on STIR and diffusion restriction.
The left testis is seen within the left scrotal sac.
Case Discussion
The presence of bilateral arterial supply and double ureters of the kidney lump is suggestive of crossed fused renal ectopia, known as pancake kidney 1.
This is associated with right-sided undescended intra-abdominal testis. The intra-abdominal location of the testis accounts for about 10% of undescended testis. It can present as an association with pancake kidney.
Semen analysis revealed azoospermia. This finding can occur either with seminal vesicle agenesis 2 or undescended testis. It has been reported that 90% of men with untreated unilateral cryptorchidism, develop azoospermia compared to 32% of managed patients with bilateral orchiopexy 3.
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