Presentation
Work up for left flank pain, fever and hematuria.
Patient Data
The lower pole of both kidneys is inclined towards the midline, and the kidneys have a horseshoe appearance.
Several stones corresponding to the lodge of the kidneys are observed, and two relatively larger adjacent stones are located in the left renal pelvis, causing filling defects.
In addition, mild hydronephrosis without hydroureter is evident on the left side.
The lower poles of both kidneys are seen pointing medially and fused across the midline by an isthmus of functioning renal tissue, with anteriorly malrotated hila denoting horseshoe kidneys.
At least five stones with a maximum diameter of 16 mm and a mean density of 1160 HU are seen in the left kidney. Additionally, there are two 8 mm 5 mm stones at the right kidney.
Mild hydronephrosis accompanied by urothelial thickening and surrounding fat stranding is noted at the left renal collecting system suggesting pyelonephritis.
Case Discussion
Horseshoe kidney with stones and evidence of pyelonephritis on the left side.
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