Presentation
Vague lower abdominal pain with dysuria.
Patient Data
Supernumerary (4 in number) fused kidneys are noted in left lumbar and midline lower abdominal regions.
There is the fusion of ectopic right supernumerary kidney (2 in number) with the ectopic left supernumerary kidney (2 in number) in midline lower central abdomen – suggestive of crossed fused ectopic right kidney.
The ectopic supernumerary right renal moieties (discoid shaped fusion) measure 8.2 x 3.2 cms (length x width) and 7.6 x 3.3 cms. Both renal moieties have their long axis in the coronal plane and are supplied by a common arterial trunk arising from the anterior wall of aorta at the level of bifurcation. The fused renal veins drain into the left common iliac vein.
The supernumerary left renal moieties (S-shaped fusion) are seen in left renal fossa measuring 6.5 x 4.4 cms and 6.9 x 4.1 cms and are supplied by separate arterial branches arising from the aorta. There is malrotation of the inferiorly located left renal moiety with renal pelvis facing towards lateral side.
Only two ureters are seen with normal insertions into the urinary bladder. There are focal areas of reduced parenchymal enhancement in both right renal moieties with delayed persistent enhancement - representing focal acute pyelonephritis.
No perinephric collections.
No calculus/hydronephrosis/hydroureter on both sides.
Case Discussion
Crossed fused renal ectopia is a rare congenital renal anomaly. Our case of bilateral fused supernumerary kidneys with crossed fused ectopia of right kidneys is even rarer in occurence.
These patients are at increased risk for pyelonephritis and other pathologies.
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