This patient is known to have horseshoe kidney came for follow up, during ultrasound examination the kidneys had abnormal orientation. During evaluation of the retroperitoneal space, renal tissue was seen anteriorly to the aorta and was initially mistaken by lymph node enlargement such as may be seen in lymphoma or metastatic nodal enlargement.

Patients with horseshoe kidney require follow up, as they may develop hydronephrosis, renal stones, recurrent infections, secondary hypertension, increased susceptibility to trauma, and various forms of malignancy.

Abnormal orientated kidneys during ultrasound evaluation should raise the suspicion of horseshoe kidney.