Crossed nonfused renal ectopia with variant blood vessels: a rare congenital renal anomaly

Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review

Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.

A case report of non-functional ectopic left kidney obstructing the right kidney in crossed fused kidneys: A rare entity

Introduction and importance

Crossed fused renal ectopia is a rare congenital condition that might pose some diagnostic and therapeutic challenges to clinicians. We report a patient with a non-functional crossed fused ectopic left kidney that obstructed the orthotopic kidney in a rarely observed situation.

Case presentation

A 68-year-old male presented a right flank pain with fever. The diagnosis of right obstructive pyelonephritis was dressed, after biological and radiological investigations. The obstacle was a crossed ectopic left kidney in its inferior variety. The ectopic kidney was non-functional as result of an obstructive ureteral calculus. The patient had right ureteral stenting with a double-J catheter. Three months later, left nephrectomy was performed by lumbotomy. Per operative difficulties were mainly the infiltration of peri renal fat, the anarchic vascularization and the multiple small pedicles of the ectopic kidney that was also malrotated with the hilum facing anteriorly. Postoperative recovery was uneventful and the patient left the hospital after three days.

Clinical discussion

Crossed Fused renal ectopy is rare. As shown in this case, the ectopic kidney might cause damage to the orthotopic kidney, by compression to urinary ducts. Surgery is the main treatment option. Some difficulties related to aberrant vascularization and possible malrotation is to preview.

Conclusion

Crossed fused renal ectopia is uncommon renal anomaly, mostly asymptomatic. However, it may be responsible of some complications, sometimes severe. Surgery can be delicate due to vascular complexity.

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Crossed renal fused ectopy is rare and asymptomatic congenital condition. Association to other malformations is possible.

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The ectopic kidney may be responsible of the obstruction and the mal function of the orthotopic kidney.

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This is the first case to be reported in literature.

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Surgery might be difficult due to aberrant vascularization and possible malrotation of the kidney.

Crossed unfused renal ectopia with pelviureteric junction obstruction associated with nephrolithiasis: a rare troublesome triad managed by robotic surgery

We report a rare case of non-fused renal ectopia with pelviureteric junction obstruction and multiple pelvic and renal calculi thereby discussing vascular anatomy of the non-fused ectopic kidney along with robot assisted surgical management of this rare clinical entity which amounts for good preoperative workup for best surgical and clinical outcome.

Congenital Anomalies of the Upper Urinary Tract: A Comprehensive Review

The upper urinary tract is the most common human system affected by congenital anomalies. Congenital anomalies of the kidneys and ureters comprise a wide spectrum of disorders ranging from simple variants with no clinical significance to complex anomalies that may lead to severe complications and end-stage renal disease. They may be classified as anomalies of renal form, which are subclassified as structural anomalies (eg, persistent fetal lobulation, hypertrophied column of Bertin, and dromedary hump) and fusion anomalies (eg, horseshoe kidney and pancake kidney); anomalies of renal position (eg, renal malrotation, simple renal ectopia, and crossed renal ectopia) and renal number (eg, renal agenesis and supernumerary kidney); and abnormalities in development of the urinary collecting system (eg, pyelocaliceal diverticulum, megacalycosis, ureteropelvic junction obstruction, duplex collecting system, megaureter, ectopic ureter, and ureterocele). US is usually the first imaging modality used because of its low cost, wide availability, and absence of ionizing radiation. Intravenous urography and voiding cystourethrography are also useful, mainly for characterization of the collecting system and vesicoureteral reflux. However, intravenous urography has been replaced by CT urography and MR urography. These imaging methods not only allow direct visualization of the collecting system but also demonstrate the function of the kidneys, the vascular anatomy, adjacent structures, and complications. Comprehension of congenital anomalies of the upper urinary tract is crucial for an accurate diagnosis and correct management. The authors discuss the spectrum of these anomalies, with emphasis on embryologic development, imaging findings, clinical manifestations, and complications. Online supplemental material is available for this article. ^©RSNA, 2021.

Coexistence of a rare type of ectopic kidney with atypical renal vasculature

Knowledge of anatomical anomalies is significant for all specialists in clinical practice and may prevent serious complications following medical procedures. This report presents the rare crossed fused renal ectopia (CFRE) with atypical renal vasculature in cadaver of a 68-year-old man. The ectopic kidney was located on right side with four renal veins, three renal arteries, two ureters, where one of them is double. The embryological background, as well as the potential clinical significance of this morphological variation, is discussed. An interventional radiological and surgical procedure should be appropriately implemented to treat anomalies of vessels and CFRE.

Evaluating the origin of vascular structures in ectopic kidneys with multidetector computed tomography

PURPOSE

The purpose of this study is to investigate the origin of the vascular structures in ectopic kidneys with multidetector computed tomography (CT).

METHODS

The abdominal CT images of 96 cases with 106 ectopic kidneys were retrospectively reviewed. The ectopic kidney location, type of ectopia, and the origins of renal arteries and veins of the ectopic kidneys were evaluated. The origins of the renal arteries and veins were classified as suprarenal aorta/inferior vena cava (IVC), normal origin, infrarenal aorta/IVC, aortic/IVC bifurcation, common iliac artery/vein, iliac bifurcation, internal iliac artery/vein, and external iliac artery/vein. Finally, the ectopic kidneys were classified according to the most common combinations of artery and vein origins.

RESULTS

The renal artery originated from the suprarenal aorta in 1 case, normal origin in 13 cases, the infrarenal aorta in 36 cases, aortic bifurcation in 50 cases, the common iliac artery in 17 cases, and the iliac artery bifurcation in 2 cases. The renal vein was of normal origin in 19 cases, originated from the infrarenal IVC in 44 cases, IVC bifurcation in 36 cases, the common iliac vein in 23 cases, the internal iliac vein in 1 case, and the external iliac vein in 1 case. We classified the artery and vein origins of the ectopic kidneys into 7 most common types and other less common types. A significant correlation was found between the level of the ectopic kidneys and the origin of the arteries and veins (P < 0.001).

CONCLUSIONS

Our study shows that the majority of ectopic kidneys have various origins of arterial and venous supply. We described the most common vascular origins of ectopic kidneys. Prior knowledge of these vascular variations may have important implications in preventing iatrogenic hemorrhage during surgery of patients with ectopic kidney.

Crossed-fused renal ectopia with renal calculi: Two case reports and a review of the literature

RATIONALE

Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date.

PATIENT CONCERNS

Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day.

DIAGNOSES

On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys.

INTERVENTIONS

Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief.

OUTCOMES

Two patients have been followed up and have no stones recurrence.

LESSONS

Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.

Crossed Unfused Ectopic Pelvic Kidneys: A Case Illustration

Crossed unfused ectopia constitutes a very rare variant of ectopic kidneys, with an approximate incidence of 1 : 75000. We hereby describe a rare case of an incidental finding of crossed unfused ectopic kidneys, in a 45-year-old gentleman incidentally found to have a bladder lesion. The unique blood supply of his kidneys has also been described. The present case also highlights the different subtypes of renal ectopia, the different embryological hypotheses behind their presentation, and the various systematic anomalies, associated with them. Variations in vasculature of ectopic kidneys have been only described in case reports and are crucial to recognize in case any further intervention is needed.