A Case of Horse-shoe Kidney
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19-Oct-2014 -
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Transcript of A Case of Horse-shoe Kidney
IMAGING OF THE WEEK
PROF.Dr.RAMASAMY’s UNIT
Dr.K.SENTHAMIZHSELVAN
32 year old female , presented with vague lower abdominal pain for
the past three months,
her BP was normal
p/a-no mass palpable
ULTRASOUND AND X RAY KUB REVEALED NOTHING CONCLUSIVE
HENCE CT SCAN WAS TAKEN
UPPER URINARY TRACT ANOMALIES
• ANOMALIES OF NUMBER
• ANOMALIES OF ASCENT
• ANOMALIES OF FORM AND FUSION• ANOMALIES OF ROTATION • ANOMALIES OF RENAL VASCULATURE • ANOMALIES OF COLLECTING SYSTEM
ANOMALIES OF NO.
AGENESIS
UNILATERAL
BILATERAL
SUPER NUMARY
ANOMALIES OF ASCENT
SIMPLE RENAL ECTOPIA
CEPHALAD RENAL ECTOPIA
THORACIC KIDNEY
ANOMALIES OF RENAL VASCULATURE
MULTIPLE/ACCESSORY
VESSELS
RENAL ARTERY ANEURYSM
RENAL AV FISTULA
ANOMALIES OF FORM AND FUSION
HORSE SHOE KIDNEY
CROSSED RENAL ECTOPIA
ANOMALIES OF ROTATION
VENTRAL DORSAL
VENTROMEDIAL LATERAL
Anomalies of collecting systemCALYX & INFUNDIBULUM; 1.CALYCEAL DIVERTICULUM 2.HYDROCALYX 3.MEGACALYX 4.UNIPAPILLARY KIDNEY 5.EXTRARENAL CALYX 6.PSEUDO TUMOR KIDNEY 7.INFUNDIBULOPELVIC DYSGENESISPELVIS 1.EXTRA RENAL PELVIS 2.BIFID PELVIS
CROSSED RENAL ECTOPIA• KIDNEY IS PRESENT ON OPPOSITE SIDE OF MIDLINE FROM ITS URETER• SLIGHT MALE PREPONDERANCE 3:2• INCIDENCE 1:1000• LEFT RENAL ECTOPIA IS COMMON EMBRYOLOGY:-URETERAL BUD ENTERS METANEPHRIC
BLASTEMA(LS SPINE);OVER THE NEXT 4 WKS.KIDNEY LIES AT L1,L3
THEORIES:-PATH OF LEAST RESISTANCE, URETERAL PHENOMENON, CLOACA&WOLFFIAN DUCT, TERATOGENICITY , GENETIC
• FUSION OCCURS AT TRUE PELVIS BEFORE ASCENT LATE STAGES OF ASCENT• ADVANCEMENT IS IMPEDED BY INFERIOR MESENTERIC A. AORTIC BIFURCATION BASE OF SMALL BOWEL MESENTERY• FINAL SHAPE OF FUSED KIDNEY DEPENDS ON TIME OF
FUSION ,EXTENT OF FUSION AND DEGREE OF ROTATION• POSITION OF RENAL PELVIS PROVIDES A CLUE TO THE
CHRONOLOGY OF DEFECT • ANTERIOR PELVIS-EARLY FUSION;;MEDIAL PELVIS-LATE
FUSION;;NO CHANGE AFTER FUSION
TYPES OF CROSSED ECTOPIA
Proximal kidney normal;distal kidney from opposite side crosses &fuses;both pelvis anterior ,ureters cross
Crossed kidney is inferior ;fusion occurs late;pelvis in opposite direction ;
Extensive union ;Ureters don’t cross
Tandem kidney;crossed kidney assumes transverse position;Both pelvis anterior ;
Doughnut kidney or pancake kidney;Pelvis anterior ;ureters uncrossed ;
Rarest ;both pelvis anterior
BLOOD SUPPLY NORMAL KIDNEY-BRANCHES OF MULTIPLE RENAL ARTERIES FROM AORTA
ECTOPIC KIDNEY –BRANCHES FROM COMMON ILIAC ARTERY,RARELY FROM AORTA
SOLITARY CROSSED KIDNEY-BRANCHES FROM AORTA or COMMON ILIAC ARTERY OF THE CORRESPONDING SIDE
ASSOCIATED ANOMALIES
CROSSED SOLITARY -HEMITRIGONE ECTOPIA POORLY DEVELOPED TRIGONE
CROSSED KIDNEY-ECTOPIC URETERAL ORIFICE,CYSTIC DYSPLASIA,PUJ.OBSTRUCTION,CARCINOMA
UNCROSSED KIDNEY-ECTOPIC URETEROCELE
VURIMPERFORATE ANUSVERTEBRAL ANOMALIES
CLINICAL FEATURES ASYMPTOMATICVAGUE LOWER ABD.PAINHAEMATURIA ,PYURIA ,UTIABDOMINAL MASSHYDRONEPHROSISRENAL CALICULI HYPERTENSION(DUE TO VASCULAR LESION IN
ANOMALOUS VESSELS)INCREASED RISK OF TRAUMA
INVESTIGATIONS&TREATMENT BASELINE INVESTIGATIONS TREATMENTIVU - SYMPTOMATIC ;
MCU - NEPHRECTOMY
USG ABDOMENCT ABDOMENRADIONUCLIDE STUDIESCYSTOSCOPYRENAL ANGIOMRI
HORSE SHOE KIDNEYTWO DISTINCT RENAL MASS,VERTICALLY ORIENTED,
ON EITHER SIDE OF MIDLINE, CONNECTED AT THEIR POLES
MOST COMMON RENAL FUSION ANOMALYINCIDENCE 1 :400MALE PREPONDERANCE 2:1EMBRYOLOGY---AT 4 WEEKS, SLIGHT ALTERATION OF
VASCULAR MORPHOLOGY LEADS TO FUSION ---POST.NEPHROGENIC CELLS MIGRATE
ABNORMALLY ,TO FORM AN ISTHMUS BETWEEN THE KIDNEYS
BOTH THE PELVIS ARE ANTERIOR INDICATING MALROTATION
INFERIOR MESENTERIC ARTERY PREVENTS ASCENT 95%-INFERIOR POLE FUSION 5%-SUPERIOR POLE FUSION ISTHMUS –PARENCHYMA _ FIBROUSBLOOD SUPPLY –BIL.MULTIPLE RENAL ARTERIES ISTHMUS-BR.OF RENAL A. /ABD.A/IMA/ILIAC A.
CLINICAL FEATURES 50% ASYMPTOMATIC LIFELONG 50% PRESENT AT LATER AGE VAGUE ABDOMINAL PAIN UTI,RENAL CALCULUS PUJ OBSTRUCTION HYDRONEPHROSISROVSING ‘S SIGNCARCINOMA-50%RCC,REST WILM’S ,RENAL PELVIC
TUMORS
ASSOCIATED ANOMALIES VSD ,NEURAL TUBE DEFECTSANO RECTAL MALFORMATIONGENITO URINARY ANOMALIES –HYPOSPADIAS, UNDESCENDED TESTIS,BICORNUATE UTERUS SEPTATE VAGINA,URETERAL DUPLICATION MULTICYSTIC DYSPLASIA,HIGH INSERTION OF URETERMETABOLIC –HYPERCALCIURIA ,HYPEROXALURIA, HYPOCITRATURIA SYNDROMES –TURNER, EDWARD &TOWNE BROCK
THANK YOU