Presentation
Persistent unexplained right loin pain.
Patient Data
Missing right kidney; completely absent (agenetic).
Crossed ectopic left kidney to the right lower lumbar region.
At the arterial phase:
- aortic anomalous high trifurcation, with end level opposite LV2, before the renal artery origin
- the aorta ends in three divisions; right and left iliac arteries and one ectopic kidney renal artery
- a second renal artery is seen originating from the right iliac artery, which is significantly displaced forward by the ectopic solitary kidney
- double renal veins ending at the left side of the IVC, which supports the fact of left sided renal origin
At the excretory phase:
- the ureter of the ectopic left kidney crossed midline back to end at the position of the left vesicoureteric orifice
- associated left renal double moiety and grade I hydronephrosis (likely positional)
Conclusion:
Solitary left renal crossed ectopia (SCRE).
Case Discussion
Solitary crossed renal ectopia (SCRE) is an uncommon congenital abnormality that occurs due to a combination of unilateral renal agenesis and renal ectopia. McDonald and McClellan classified renal ectopia into four types:
- crossed renal ectopia with fusion
- crossed renal ectopia without fusion
- solitary crossed renal ectopia
- bilaterally crossed renal ectopia
Only 34 patients of SCRE has been reported in the literature until date 1,2.
Case contributions from Dr Amro Saadawy; Lecturer of diagnostic imaging. Ein Shams University, Egypt.