Left Ectopic Kidney Research Articles

A Diagnostic Pitfall in a Patient with Acute Abdominal Pain: Congenital Hydronephrosis/Hydroureter Misdiagnosed as Hydrosalpinx

Clinical manifestation or incidental finding of congenital kidney anomalies are more often discovered during pregnancy. Even if the acute presentation (in the antenatal period, as in this case) precludes a full diagnostic workup, assiduous follow-up and investigations in the postnatal period will resolve the initial uncertainty. This is not a new phenomenon based on literature and urologic differential diagnoses such as an ectopic urinary system which should always be entertained and excluded prior to making the diagnosis of an adnexal mass. We present a case of 33-year-old woman with acute abdominal pain and a previous obstetric (mis)diagnosis of hydrosalpinx (based on ultrasonography) made 8 years before presenting to the emergency department with acute lower abdominal pain, fever, chills and rigors. Current investigations revealed congenital abnormal kidneys bilaterally, with ectopic left kidney and grossly infected hydronephrosis, which was likely the fluid-filled mass initially mistaken for a hydrosalpinx. She then underwent left nephrostomy and later had simple left nephrectomy. This case highlights the importance of making an accurate diagnosis and arranging careful follow-up of the female patient presenting with a “cystic” mass of the pelvic region during pregnancy.

An unusual presentation of May–Thurner Syndrome in a pediatric patient with a pelvic kidney

We report a case of an adolescent who presented with a deep vein thrombosis (DVT) and clinical findings consistent with May–Thurner Syndrome. Specific imaging demonstrated direct compression of the left common iliac vein by an overlying pelvic kidney. The patient's history and clinical presentation is detailed. The discussion focuses on the potential implications for care and management of a patient with an ectopic left pelvic kidney.

Renal cell carcinoma in a crossed ectopic kidney

Figure 1. Left crossed ectopic pelvic kidney in the lower lumbar and pre-sacral region with a neoplastic lesion. Figure 2. The tumour forming a bulge at the lower part of the root of the mesentry. pre-sacral, crossed ectopic kidney. The CT urography revealed a radiologically neoplastic mass in the leftto-right renal ectopia which was found in the lower lumbar and pre-sacral region (Figure 1). Well excreting right kidney was found in the normal position not attached to the ectopic left kidney.

Dyshormonogenetic goiter and associated non-thyroidal anomalies

Background: Dyshormonogenetic goiter (DG) refers to familial goitres owing to an inherited defect in the metabolism of thyroid hormones and accounts for 10-15% of all cases of congenital hypothyroidism. Aim and Objective: To identify dysmorphic features, cardiac and urogenital anomalies in patients with DG following in the pediatric endocrinology clinic. Materials and Methods: Eight adolescents following the pediatric endocrinology clinic for hypothyroidism and associated stigmata were identified with dyshormonogenesis using 99mTc radionuclide thyroid scintigraphy and confirmation by the Perchlorate discharge test during a 6-month period from January to July 2012. Screening for associated malformations was done using clinical examination, echocardiography and ultrasonography of abdomen. Results: The eight patients (two boys and six girls) had a mean age of 9.87 years. The mean duration of goitre was 36.12 months. Two patients had mental retardation and delayed developmental milestones one of whom had ectopic left kidney on renal scintigraphy. Mitral regurgitation was seen in one patient whereas renal anomalies in the form of ectopic kidney and small/contracted kidney with grade III hydronephrosis was seen in two patients. Penoscrotal hypospadias was identified in one of the patients who also had small/contracted kidney with grade III hydronephrosis and underwent pyeloplasty for the same. Dysmorphic features in the form of high arched palate, depressed nasal bridge and low set ears was seen in one patient. Conclusion: DG is associated with other extra-thyroidal congenital anomaly, some of which may need to be treated.

Molecular analysis of WNT4 gene in four adolescent girls with mullerian duct abnormality and hyperandrogenism (atypical Mayer-Rokitansky-Küster-Hauser syndrome)

In a collaborative study, we investigated four 46,XX adolescent girls with Mayer-Rokitansky-Küster-Hauser syndrome and hyperandrogenism. Molecular analysis of the WNT4 gene permitted us to identify a new mutation (p.A233T). Functional studies revealed partial repression of steroidogenic enzymes (normal repression of HSD3B2) contrasting with the abnormal reexpression of CYP17A1 enzyme in the OVCAR3 cell line. This fourth new WNT4 mutation confirms that this signaling molecule is involved in mullerian development and androgen biosynthesis repression in the ovary. Interestingly, this mutant partially lacks the capability to repress ovarian steroidogenic enzymes, with abnormal expression of 17α- hydroxylase.

Giant Hepatic Hemangioma and Cross-Fused Ectopic Kidney in a Spaceflight Participant

Commercial spaceflight participants are typically older than traditional astronauts and often have medical conditions that make medical certification for flight difficult. This case report considers a 43-yr-old spaceflight participant who planned a short-duration Soyuz flight to the International Space Station (ISS). While he participated in many hazardous activities such as parachuting, hang gliding, scuba diving, Antarctic and jungle exploration, and deep sea submersible operations, he knew that several of his medical conditions precluded serving as a career astronaut. At the time of his initial spaceflight prescreen examination, he was known to have previous bilateral photorefractive keratectomy (PRK) for myopia and a cross-fused left ectopic kidney that would be disqualifying for a career astronaut. During the evaluation for the left single cross-fused ectopic kidney, a giant hepatic hemangioma was also discovered. In order to medically qualify for flight, the giant hepatic hemangioma was surgically removed. This case summary investigat*es the implications of a single cross-fused left ectopic kidney and the decision process and treatment implications for spaceflight medical certification in an individual with an asymptomatic giant hepatic hemangioma.

Multiple Non-Responding ESWL Lithiasis in Ectopic Pelvic Kidney: Laparotomic Surgical Management

A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4x2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.

An Unusual Case of Non-Functioning Crossed Renal Ectopia Without Fusion

An Unusual Case of Non-Functioning Crossed Renal Ectopia Without Fusion

Case Report: Laparoscopic Ureteral Reconstruction with Pelvic Flap in Ureteropelvic Junction Obstruction of Ectopic Left Kidney

A 33-year-old woman with ureteropelvic junction obstruction in an ectopic left kidney underwent laparoscopic pyeloplasty. Because of dense adhesions and a short ureter, we reduced the pelvis and created a tubularized pelvic flap using the Endo-GIA device to form a neoureter. No major complications were observed. A 6-month postoperative three-dimensional CT scan showed good renal function without hydronephrosis.

Síndrome de Goldenhar: relato de caso

<span class="texto">A Síndrome de Goldenhar é uma condição rara, geralmente de ocorrência esporádica, caracterizada por microssomia hemifacial, dermóide epibulbar, más formações do pavilhão auditivo e anomalias vertebrais. Existem também relatos de associações da síndrome com outras condições sistêmicas. Os autores relatam um caso de Síndrome de Goldenhar em paciente do sexo feminino, 28 anos, sem antecedentes familiares, que apresentava microssomia hemifacial, o que comprometia os músculos da mastigação, a expressão facial e os ossos da face (mandíbula, maxila e zigomático) do lado esquerdo, presença de broto auricular, história médica de dermóide epibulbar e fissura lateral de face, ipsilateralmente. Na avaliação sistêmica, foram encontrados ectopia do rim esquerdo e discreto espessamento dos folhetos mitrais, com refluxo mitral de grau leve.</span>

An unusual cause of lower gastrointestinal bleeding: A case report and a review of literature

This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. He was also found to be cirrhosis and to have an ectopic left kidney in the midline over the roof of the mesenteric vessel. He was treated successfully by performing a right hemicolectomy.

HETEROZYGOTIC TWINNING IN A CASE OF FEMALE VESICOURETHRAL DUPLICATION

A 45-day-old female born at term after a normal pregnancy was referred for a urogenital malformation. Physical examination demonstrated normal vaginal introitus, urethra and labia minora. The upper part of the left labium presented as a 6 3 cm cylindrical mass and a clitoris-like structure with an accessory urethra located at the base. The anus was normally located (fig. 1). Blood, urine, renal function and hormone stimulation analyses were normal, and karyotype was 46,XX. Abdominal ultrasonography showed a normal right kidney and a hypoplastic ectopic left kidney with 2 bladders. The uterus and ovaries were normal. Retrograde cystourethrogram through the orthotopic urethra filled a bladder and induced grade II vesicoureteral reflux to the right kidney. That performed through the ectopic urethral meatus filled a second bladder located posterolaterally to the first one and induced vesicoureteral reflux to an ectopic left kidney. Cystoscopy confirmed 2 normal appearing bladders lined by normal mucosa, each receiving a corresponding ureter. Both urethras were also normal. At surgery 2 completely independent bladders were found together with an ectopic hypoplastic kidney, bicornuate uterus, 2 ovaries, a 36 cm long cecal prolongation resembling a mega-appendix and 1 vas deferens. The mega-appendix, left hypoplastic kidney, bladder, ectopic urethra and vas deferens were removed. No rudimentary gonadal tissue or testis was identified. Finally, the pubic mass was excised and vulvoplasty was performed. Pathological studies determined that the removed urethra was surrounded by prostatic tissue into which a blind ending vas deferens opened (fig. 2). Examination of the pubic mass revealed a chondrolipoma. Molecular studies for gender investigation were performed. Genomic DNA was extracted from paraffin blocks of kidney tissue, clitoris and vas deferens taken during surgery. DNA analysis was performed using polymerase chain reaction. Amplified products were electrophoresed on acrylamide gel and visualized using silver staining. Four of the loci tested on chromosomes 3, 9, 12 and 21 demonstrated different alleles, indicating the presence of 2 diploid genomes. Thus, haplotyping showed the heterozygotic origin of both duplicated elements. Fluorescent in situ hybridization was performed using an X centromere probe DX21 and Y cocktail probe but the results could not confirm 2 different genders. DISCUSSION

Pelvic hydronephrotic kidney masquerading as obstructed bowel

A 6 year-old boy presented to an outlying hospital with a 4-day history of abdominal discomfort, constipation, and emesis. An initial computed tomography scan of his abdomen was done without intravenous contrast, and the findings were initially believed to represent a small bowel obstruction (Fig. 1A; see next page for figures). He was referred to our institution for additional treatment. The physical examination revealed a blood pressure of 142/103 mm Hg and a firm lower abdominal mass. The serum creatinine was 0.8 mg/dL. Contrast-enhanced computed tomography of the abdomen and pelvis was performed to delineate the patient’s abnormality more clearly. This revealed the absence of an orthotopic left kidney (Fig. 1B) and a large left ectopic kidney (Fig. 2A), with contrast pooling in the collecting system on delayed images (Fig. 2B). Most ectopic kidneys are asymptomatic and discovered incidentally. However, in a retrospective series, Gleason et al.1 reported that one quarter of 77 patients presenting with renal ectopia were initially evaluated for gastrointestinal complaints. When an orthotopic kidney is not identified, a high index of suspicion for ectopia should guide the imaging choices. Although a variety of imaging modalities can appropriately suggest the diagnosis, contrast-enhanced computed tomography can verify the diagnosis if the ectopic kidney exhibits function.

Thoracic Kidney Associated with Partially Intrathoracic Spleen: CT and MRI Findings

A 51-year-old man was admitted to our hospital with intermittent fever and fatigue. Clinical examination revealed liver cirrhosis and splenomegaly. Helical CT of thorax was performed to investigate an elevated left hemidiaphragm and a functioning left ectopic kidney was discovered (Fig. 1). MRI in multiple planes was performed with fast imaging with steadystate precession (FISP) to delineate the exact size and extent of the defect. On CT and MR images the left kidney showed a rotation abnormality and was situated completely above the diaphragm (Fig. 2). Its size, parenchymal thickness and collecting system were normal. The origin of the left renal artery from the abdominal aorta was at the normal level and the renal vessels were elongated (Fig. 3). The posterior part of the enlarged spleen was also above the diaphragm (Fig. 4). The left adrenal gland was in its normal location. The patient had no history of trauma and his renal function tests were normal.

Ureterocystoplasty: An alternative reconstructive procedure to enterocystoplasty in suitable cases

Purpose: The objective of the report is to present the results of ureterocystoplasty in 6 children with megaureters and low-capacity, high-pressure bladders. Methods: Of the 6 patients, 2 had valve bladders, 1 had Hinmann's syndrome, 1 had neuropathic bladder, and the remaining 2 with ureterocutaneostomy were mainly diverted because of refluxing megaureters. Nephrectomy was performed in both of the boys with posterior urethral valve because of vesicoureteral reflux dysplasia (VURD) syndrome, and the ipsilateral ureter was used for the augmentation. In 2 patients with ureterocutaneostomy and in 1 with Hinmann's syndrome, a transureteroureterostomy was carried out, and the distal part of the ureter was used to perform augmentation. The patient with neuropathic bladder had a nonfunctioning crossed ectopic left kidney with an associated ipsilateral, refluxing megaureter, and the ureter was used for augmentation after the nephrectomy. Results: All of the patients are continent, and 4 patients who are neurologically normal void spontaneously without requiring clean intermittent catheterization (CIC). The average increase in bladder capacity is 263% (range, 190% to 340%). Conclusions: Ureterocystoplasty is the bladder augmentation of choice for patients with a nonfunctioning kidney with an associated ipsilateral, refluxing megaureter and for patients with kidneys both in good function and megaureters suitable for a transureteroureterostomy. J Pediatr Surg 35:577-579. Copyright © 2000 by W.B. Saunders Company.

Removal of an ectopic left kidney through a ventral midline celiotomy in a calf

Removal of an ectopic left kidney through a ventral midline celiotomy in a calf

Crossed fused Ectopic Kidney - A Case Report

We present a case of crossed-fused ectopic left kidney in a young man who came with rightsidedabdominal pain for about 5 months. Crossed-fused ectopic kidney is often associated withother congenital anomalies, especially in the urinary tract. Our patient had two anomalies-ananomalous placement of renal pelvis (laterally in the orthotopic kidney), and a high up caecum,which was an asymptomatic associated gastrointestinal tract anomaly.doi: 10.3329/taj.v16i2.3889TAJ December 2003; Vol.16(2): 79-81

Absence of the vagina, uterus, right kidney and ureter and ectopic (pelvic) left kidney

Absence of the vagina, uterus, right kidney and ureter and ectopic (pelvic) left kidney

The ectopic kidney—A gynecological diagnostic problem with case report

1. 1. An interesting and undiagnosed case of asymptomatic ectopic kidney is presented. The error of omission committed here is of teaching value. 2. 2. Contralateral bladder distortion from chronic inflammatory adhesions produced the urinary syndrome on the contralateral side. 3. 3. Preoperative x-ray, because of intestinal shadows, did not reveal an ectopic kidney. 4. 4. The importance of proper preparation of the patients for x-ray is stressed by this case. Postoperatively, pyelography confirmed the laparotomy findings of left ectopic kidney. 5. 5. An ectopic kidney should be suspected when a low retroperitoneal pelvic mass is felt, even when it is fixed to the anterior abdominal wall. 6. 6. The rarity of this condition, the atypism of the symptoms, and the instructive elements of the case warrant reporting.

LEFT RENAL DYSTOPIA: CASE REPORT

This case demonstrates the beneficial effect of drainage upon a badly infected and obstructed renal system. If the anatomical relations of the left ectopic kidney to the vena cava and the aorta had been known prior to operation, a nephrectomy of the displaced kidney mass would not have been considered. While the surgical procedure was palliative and conservative in character, it did provide drainage to the dystopic kidney. This uretero-pelvic anastomosis enabled the patient to resume her normal activities in comparative comfort and undoubtedly extended her life span.