Recurrent right illiac fossa (RIF) pain
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3D reconstructed CT images in the delayed phase, shows the two native kidneys in the lumbar quadrant and an accessory kidney in the RIF. The hilum of the supernumerary kidney is found to be facing anteriorly and the ureter joins the distal right ureter. No other additional upper urinary tract anomalies are seen.
(Technique : 3 D reconstructed volume rendered CT images ; 130 Kv, 58 mA. 5 mm slice thickness in delayed phase ; 15 minutes post intravenous administration of 100 ml of 370 mg of Ultravist).
A 45 year old male presented with recurrent right illiac fossa (RIF) pain. The pain was dull aching and increased on supine position. On US there was a reniform shaped mass in the RIF, with hypoechoic periphery and central hyperechogenicity. On closer examination there was central vascularity and a hilum identified. The vessels showed a renal vascular waveform. An Intravenous Urogram (IVU) was performed, which showed uniform and homogenous enhancement of all three kidneys and adequate excretion from the three kidneys. The accessory kidney's ureter was seen to be joining the native right ureter. However, there was minimal compression of the right ureter by the accessory kidney. Contrast Enhanced CT of the abdomen was undertaken for finding any parallel cause for the recurrent abdominal pain. CT taken confirmed the findings of ultrasound and IVU.
Further evaluation of the patient demonstrated no other urogenital abnormalities. On the basis of the patient having symptoms on supine posture, demonstration of minimal compression of the right ureter by the accessory kidney on imaging and lack of any other cause of pain being demonstrated, the probability of the accessory kidney's compressive symptoms causing pain was put forth and patient was advised postural alteration. No surgical correction was advised as this kidney was the better functioning one.
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