Phantom kidney on perfusion renal imaging

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A 67-year-old male presented with sudden onset of right flank pain and anuria. On examination he had signs of acute renal failure. An intravenous urogram showed a large right with poor filling of the lower pole calyceal system suspicious for having a renal mass. The left was not visualized. Renal ultrasonogram showed that the right was enlarged and measured 16 • 8 cm. There was distortion of the echo pattern at its lower pole while the remainder of the was unremarkable. No left could be identified. On the perfusion images of a 99~Tc-glucoheptonate renal scintiscan (Fig 1) there was prompt and relatively homogeneous perfusion to the right and there was simultaneous equal perfusion to a kidney like organ on the left side. On the static renal images (Fig 2) there was good uptake in the upper two-thirds of the right but decreased uptake in its lower pole. The well perfused organ in the left upper quadrant was very poorly visualized with its uptake similar to the uptake of the liver. A CT abdomen scan (Fig 3) clarified that there was no left kidney, and the spleen had migrated into the empty renal fossa causing a phantom on the perfusion renal images. The soft tissue mass in the lower part of the