Situs inversus totalis with horseshoe kidney

Case contributed by Dr Abanindu Thakur

Presentation

Increased frequency of micturition and right lumbar pain

Patient Data

Age: 40 years
Gender: Female

The inverted position of the liver, gall bladder, spleen, pancreas, stomach, small and large bowel is seen.

Small splenunculus is seen in the right sub-diaphragmatic location.

The abdominal aorta is in the midline, while the inferior vena cava is left-sided.

The lower pole parenchyma of both kidneys is fused in the midline. Both kidneys are malrotated, with their pelves facing anteriorly. The left kidney is dysmorphic and atrophic. However, both kidneys show excretion of contrast. The right extrarenal pelvis is noted. The upper and mid parts of the right ureter are dilated.

The uterus and ovaries are not visualized (post-hysterectomy and bilateral salpingo-oophorectomy case).

Dextrocardia is evident.

Case Discussion

The viscera normally seen on the right side are located on the left, and vice versa 1. The inverted position of abdominal organs in a mirror image 2 fashion is suggestive of situs inversus. Along with dextrocardia (as in this case), the condition is known as situs inversus totalis.

Accessory spleen or splenunculus (seen in this case) has an association with situs inversus 2.

The midline fused lower pole parenchyma of both kidneys is suggestive of a horseshoe kidney. Both kidneys are malrotated, and the left kidney is dysmorphic. Right-sided hydroureter is noted.

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