The Rarest of the Rare: Crossed Fused Renal Ectopia of the Superior Ectopia Type

Renovascular hypertension - a primer for the radiologist

Renovascular hypertension (RVHT) is an important cause of secondary hypertension, accounting for approximately 75% of cases. This pictorial review describes the imaging modalities used to diagnose RVHT, including ultrasound, computed tomography angiography, and magnetic resonance angiography, provides their benefits and limitations, and explores the imaging findings, diagnostic criteria, and management of multiple causes of RVHT. Atherosclerosis is the most common cause of RVHT, particularly in older individuals, while fibromuscular dysplasia is more prevalent in younger females. Less common discussed etiologies include polyarteritis nodosa, extrinsic compression, Page kidney, dissection, renal artery (RA) thrombus, and RA aneurysms. This paper also highlights the importance of recognizing anatomical variants and rare conditions that can impact diagnosis and management. While RVHT represents a minority of hypertension cases, its potential reversibility makes accurate diagnosis crucial. Treatment approaches vary based on etiology and may include medical management, angioplasty, stenting, or surgical intervention. This review aims to enhance radiologists' understanding of RVHT, facilitating improved diagnosis and patient care.

Renal cell carcinoma in a patient with crossed and fused renal ectopy: A case report

Crossed-fused renal ectopia (CFRE) is a rare congenital disease in which one of the kidneys with its ureter crosses the midline and fuses with the contralateral kidney. The association of this malformation with the presence of primary renal cell carcinoma (RCC) is even more anecdotal; there are only a few cases reported in the literature. We describe the case of a 62 year-old man with CFRE associated with renal cell carcinoma, which was successfully removed by retroperitoneoscopy, after careful preoperative study of blood supply and anatomical features.

Renal Cell Carcinoma in a Patient With Crossed Renal Ectopia: A Case Report

Crossed fused renal ectopia (CFRE) is a rare congenital anomaly in which a kidney is located on the opposite side from where its ureter connects to the bladder, merging into the other kidney. It has been linked to other rare congenital malformations, including the VACTERL association (vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula, esophageal atresia, renal anomalies, and limb abnormalities), the MURCS association (müllerian ducts, renal, and cervicothoracic spine anomalies), increased incidence of infections, obstruction, cystic dysplasia, and urolithiasis. Although the literature has documented only a small number of cases wherein CFRE coincides with neoplasia, we present the case of a 59-year-old patient with a right ectopic kidney fused to the left one and simultaneous primary renal cell carcinoma. We aim to report and discuss this case and the treatment approach, comparing it with existing literature to enhance our understanding and management of similar occurrences, as partial nephrectomy is uncommon due to the challenging anatomy of these cases.

Ultrasound and magnetic resonance imaging features of fetal urogenital anomalies: A pictorial essay

This pictorial essay focuses on ultrasound (US) and magnetic resonance imaging (MRI) features of fetal urogenital anomalies. Fetal urogenital malformations account for 30%-50% of all anomalies discovered during pregnancy or at birth. They are usually detected by fetal ultrasound exams. However, when ultrasound data on their characteristics is insufficient, MRI is the best option for detecting other associated anomalies. The prognosis highly depends on their type and whether they are associated with other fetal abnormalities.

Case Report on Crossed Fused Renal Ectopia With a Large Calculus and Its Management

Among congenital renal anomalies, the ectopic kidney is a rare occurrence. Crossed fused renal ectopia (CFRE) - an even rarer subtype of ectopic kidney - is characterized by both kidneys being fused together on one side of the spine. CFRE is usually asymptomatic but can present with vague symptoms if the anomalous kidney becomes infected, is obstructed by calculus, or has a neoplastic change. There is no indication for surgical intervention if the kidney functions normally. This report presents a case of CFRE in a 31-year-old male with recurrent right flank pain resulting from a large calculus in the upper moiety of the fused kidney. The calculus was surgically removed by percutaneous nephrolithotomy (PCNL). The patient was discharged on analgesics, antibiotics, and potassium citrate tablets, with an order to follow up after one month. On follow-up, the patient’s double-J (DJ) stent was removed and an X-ray was performed to rule out any complications. No signs of stones, strictures, or other complications were noticed.

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.

Crossed complete fused left to right renal ectopia with solitary left ureter: A rare ‘Case Report’

Background

Crossed fused renal ectopia is a rare congenital anomaly where both the kidneys are fused and situated on one side and drain bilaterally into the urinary bladder. Rarely crossed fused ectopia can present with a single ureter draining ipsilaterally into the bladder, but here we are presenting for the first time a rare case of right crossed fused ectopia, where a solitary ureter crosses midline and drains contralaterally into the bladder.

Case presentation

A 19-year-old adolescent male patient presented with intermittent chronic right flank pain for 3 months. General physical and per abdominal examinations were normal. Computerized tomography (CT) urography showed right side crossed fused ectopic kidneys with a solitary ureter draining both the kidneys and opening into the left side of the urinary bladder. The patient was managed conservatively and is on regular follow-up.

Conclusion

Crossed complete renal fused ectopia with solitary contralateral ureteral is a rare case. Individualized case-based management is needed depending upon the symptoms, associated anomalies, and pathology. Reporting of all rare congenital cases will help in the future understanding and management of these conditions.

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.

Primary renal cell carcinoma in crossed fused ectopia: Nephron sparing surgery for a rare of rarity entity

Primary renal cell carcinoma (RCC) in crossed fused renal ectopia represents a rare of rarity entity. Only eight cases were reported in the literature, including seven RCC and one transitional cell carcinoma. This report presents a case of a 39-years old female presented with incidentally discovered renal mass in a crossed fused ectopia. Careful preoperative planning and meticulous delineation of renal vasculature were performed to avoid unpredicted anatomy. Nephron-sparing surgery with preservation of the normal-functioning moiety was performed with uneventful postoperative course. These clinical, morphological and immune-histochemical features will be presented with a review of the current literature.

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.

Crossed Fused Ectopic Kidney: A Case Report

Crossed fused ectopic kidney is an unusual congenital malformation of the urinary tract. This condition is usually identified in the autopsy specimen rather than in general clinical scenario. In this condition, both kidneys are located on one side of the midline and are fused with each other. This condition is generally asymptomatic and usually diagnosed as incidental finding. We came across a case of crossed fused left to right ectopia with inferior infusion with nephroptosis. Generally, in cases of crossed fused renal ectopia, one kidney is lower than the other one but in our report, both kidneys were present at the same level. Initially it was thought as cake kidney, but on careful inspection diagnosis of crossed fused left to right ectopia with inferior infusion was made. During workup of abdominal pain, this finding was detected with no gross abnormality except for a tiny calculus. After detailed discussion with the patient, regular follow up was done without any active intervention and during that period he remained clinically and radiologically stable. So in these conditions active intervention is not always mandatory and patient may remain asymptomatic without any intervention.

Comparison of glomerular filtration rate measured between anterior and posterior image processing using Gates' method in an ectopic pelvic kidney

Objective

The aim of this study was to evaluate the difference in measured glomerular filtration rate (GFR) of an ectopic pelvic kidney between anterior and posterior image processing using Gates’ method of renal dynamic imaging.

Methods

A total of 10 patients were studied retrospectively, with a single ectopic kidney in the pelvic cavity and a contralateral kidney at its normal anatomical position confirmed by ultrasound, computed tomography, renal dynamic imaging, etc. All images of ectopic kidneys were processed, and GFRs were measured using anterior and posterior Gates’ method of renal dynamic imaging, respectively. The contralateral normal kidney was only processed on posterior imaging. The total GFR_ant of one patient, which was equal to the sum of the GFR of a normal kidney on posterior imaging and the GFR of an ectopic kidney on anterior imaging, was compared with the total GFR_post of two kidneys on posterior imaging, with the GFR_two-sample from the two-sample method, and with the estimated GFR in the Chronic Kidney Disease Epidemiology Collaboration equation. All correlation analyses were carried out between GFRs obtained from three methods, and all patients were followed up. For statistical analysis, nonparametric rank tests were used, Bland-Altman graphs were plotted.

Results

The mean GFR of the ectopic kidney on anterior imaging was 27.48±12.24 ml/min/1.73 m². It was higher than the GFR (10.71±4.74 ml/min/1.73 m²) on posterior imaging (t=−2.803, P<0.05). There were statistical differences between the total GFR_ant and the total GFR_two-sample (Z=−2.295, P<0.05), between the total GFR_ant and the total GFR_post (Z=2.599, P<0.01), between the total GFR_two-sample and the total GFR_post (Z=−2.191, P<0.05), and between the total GFR_ant and the estimated glomerular filtration rate (Z=−2.803, P<0.01). The bias of the total GFR_ant was different from that of the total GFR_post (Z=−2.191, P<0.05). There were no differences in the precision and accuracy within 30% of the total GFR_ant and that of the total GFR_post (precision: F=0.351, P>0.05), but there were statistical differences in the accuracy within 10% of the total GFR_ant and that of the total GFR_post (P<0.05).

Conclusion

The GFR measured using Gates’ method of anterior image processing was more accurate than the GFR obtained on posterior image processing in reflecting the function of an ectopic pelvic kidney in renal dynamic imaging.