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Crossed fused renal ectopia is a rare anomaly remaining asymptomatic by far and detected invariably as either incidental finding or in view of pre-existing kidney disease. We report a case of crossed fused renal ectopia presenting as lumbar pain in a young female patient with no associated calculus or cystic kidney disease. It was an inferior type of renal ectopia on right side drained by a common artery and common ureter along with additional aberrant vascular supply. Multidetector computed tomography with multiplanar and three dimensional reconstruction helps in the proper delineation of renal fusion and ureteric anomaly if any, as well as mapping of aberrant vascular supply.

Renal ectopia anatomically results from altered migration of kidneys to their normal position in the lumbar region. Few case reports have been reported in literature. Visceral-tissue variation was in form of quadratus lumborum and psoas major in place of the RT kidney. A 21 year old female with positive HCG (pregnancy test) presented for radiological (ultrasound) confirmation of cyesis, though no sonic evidence of gravidae was observed (< 5 wks GA); confirmatory ectopic kidney was diagnosed on completion of ultrasound. This report underscores the importance of imaging the RT groin and illiac region before surgical intervention thus preventing iatrogenic injury genesis. Treatment of this condition will depend on the functional capacity of the kidney, while nephrectomy is recommended for ‘static’ non-functional kidneys. Non-complicated cases and anatomic variation can be managed conservatively.

The most frequent anomaly of the urogenital tract is a simple renal ectopia with one organ lying in the pelvis. Crossed renal ectopia is a less common condition in which the ectopic kidney is located on the opposite side of the midline from the ureteral insertion in the urinary bladder. The cause of both types of renal ectopia is the arrest or failure of the kidney ascent from the pelvic to the lumbar position. Whereas an accelerated ascent leads to a subdiaphragmal or intrathoracic ectopic position, an ectopic ureter can be defined as one that does not drain into the trigonum vesicae. The ectopic orificium can be located situated in the bladder neck and urethra as well as somewhere in the genital area. Exstrophy of the urinary bladder is not a complete ectopia. Because the abdominal wall and the anterior part of the bladder wall are lacking, the bladder mucosa grows directly into the skin. The complex exstrophy of the bladder and intestine corresponds to a cloacal exstrophy, in which the bladder is split in two halves on either side of the gut portion. Testicular ectopia refers to the location of the testis in a position outside of its normal course of descent. Prostatic ectopia does not refer to the wrong location of the entire organ, but to a scattered group of prostate glands, which are mostly found in the submucosal part of the urinary bladder or proximal urethra. Other described locations are the intestinal wall, anus, pericolic fat tissue, spleen, seminal vesicle, testis, and cervix uteri. The associated ectopic penis, scrotum, and penoscrotal transposition are the least common and probably the absolutely most unknown malformations of the male genitalia. The ectopic penis and scrotum are located in the perineum, whereas in the transposition the penis lies above the scrotum.

Renal ectopia with stone is a rare case with no specific reported incidence rate. The treatment of kidney stone in ectopic kidneys poses a challenge to urologists. A 48-year-old male presenting with colicky pain on the right flank since one year ago. CT urography revealed an right-crossed renal ectopia and hyperdense lesions (25 × 20 mm and 10 × 10 mm) in the ureteropelvic junction of the right kidney. Under general anesthesia, we performed open pyelolithotomy for the patient and removed two stones completely. Open surgery could be the choice for patients with complex stone burden and associated renal anomalies such as ectopic kidney.

Horseshoe kidneys are a common, yet enigmatic, renal malformation. This review critically appraised the literature surrounding the embryology, etiology and clinical anatomy of horseshoe kidneys. The systematic literature search produced 104 articles, and 56 primary and further secondary references. There were several etiological theories regarding horseshoe kidneys. The established view was that during ascent, the kidneys come into close apposition as they pass through an arterial fork. Another possible mechanism related to lateral flexion of the trunk or rotation of the caudal embryo; the association of asymmetrical horseshoe kidneys with a number of vertebral conditions supported this hypothesis. More recent animal models implicated the notochord and sonic hedgehog signaling. Furthermore, it has been suggested that the isthmus may be the result of ectopic mesenchymal tissue. Surgical anatomy of the horseshoe kidney is complex, due to variability in location, orientation and blood supply. Both arterial and venous anatomy is highly variable. This raised the question of whether anomalous blood supply is the cause or result of abnormal renal position. In the majority of cases, the isthmus contained functional renal parenchyma. In over 90% of cases, fusion between the kidneys occurred at the lower pole. Despite commonly being quoted as 'held back by the inferior mesenteric artery' at L3, in reality the isthmus was only found immediately inferior to this in 40% of cases.

Duplication of the inferior vena cava (IVC), a rare anomaly reported to occur in 0.2-3% of the population and is known to be associated with various urogenital tract anomalies such as horseshoe kidneys, crossed fused ectopia and circum-aortic renal collar, retroaortic left renal vein and cloacal exstrophy. Inferior vena cava anomalies are rare, Some of such variations have significant clinical, surgical and radiological implications related to other cardiovascular anomalies and in some cases associated with venous thrombosis of lower limbs, particularly in young adults due to the inappropriate venous return increases the pressure, leading to blood stasis in lower extremities and development of varices. Left-sided IVC may cause misdiagnosis with para-aortic lymph node enalargement, and may cause difficulties in the transjugular approach for IVC filter implantation. So, these anomalies should be recognized carefully.

Renal ectopia is a rare anomaly which may occur due to an abnormal ascent of the kidney. It is usually asymptomatic and does not require treatment. Intrathoracic renal ectopia with concomitant congenital diaphragmatic hernia (CDH) is extremely rare. All symptomatic CDH cases must be treated with open or thoracoscopic repair. During plication of the diaphragm, care must be taken to avoid renal injury. Following, we present two rare variants of CDH with concomitant renal ectopia managed thoracoscopically. Postoperative recovery was uneventful. Doppler ultrasound study performed one month after surgery confirmed normal vascularity of the kidneys and the absence of urinary outflow obstruction. KEYWORDS : Congenital diaphragmatic hernia; Renal ectopia; Thoracoscopic repair

Ectopic thoracic kidney is an extremely rare condition caused by the abnormal location of one or both kidneys in the thoracic cavity. They are usually discovered incidentally on routine imaging. Although commonly asymptomatic, thoracic kidneys are at a risk of malrotation, pelviureteric junction obstruction, and subsequent obstructive nephropathy, by virtue of their long pedicle. We present a case report of an incidental thoracic kidney, for which a 99mtechnetium-mercaptoacetyltriglycine (99mTc-MAG3) renogram was performed to assess the baseline renal function. Although few reports are published in the literature using 99mTc-MAG3 renogram for this indication, we demonstrate a safe and feasible study to establish a baseline assessment of renal function in this group of patients.

Objectives Microtia is a congenital ear anomaly that hinders quality of life. Microtia patients, both syndromic and in isolation, may be at-risk for significant renal anomalies that can go undetected at the time of birth. The goal of this study was to characterize the prevalence of renal anomalies among microtia patients at our institution in order to guide optimal patient management. Current guidelines suggest performing a renal ultrasound when there is presence of preauricular pits and ear anomalies in association with dysmorphic features, but not in cases of isolated microtia and atresia. Design A retrospective review of 237 children with microtia was conducted from 2001 through 2018 at our tertiary-care pediatric institution, of which 98 also had a documented renal ultrasound. Patients were identified as syndromic or non-syndromic. Data endpoints included renal ultrasounds performed, structural anomalies found, and follow-up. Results Among the 237 patients, 98 had received renal ultrasounds. 12% of the total cohort was found to be syndromic, the most common being Goldenhar. Structural anomalies were detected in 24% of the 98 patients that underwent ultrasound and included disorders such as pelviectasis, renal ectopia, duplicated collecting systems, and renal agenesis. A third of patients with anomalies required follow-up with nephrology for chronic kidney disease or renal failure. Of note, 21% of non-syndromic patients and 43% of syndromic patients screened had an abnormality on ultrasonography. Conclusions Children with microtia are at a significant risk of structural renal abnormalities, even when isolated outside of a genetic syndrome. We recommend the strong consideration of performing a screening renal ultrasound in all patients with microtia. Prospective data would be helpful in developing future clinical guidelines regarding the utility of screening ultrasonography.

Introduction: There are no specific recommendations for the surgical management of crossed fused renal ectopia (CFRE), but a laparoscopy has been proposed in a limited number of children. We report the case of a complex CFRE with severe hydronephrosis in a child treated by laparoscopic nephrectomy. Case report: A 2-year-old boy was admitted for hip and abdominal pain. A CFRE was diagnosed. Laparoscopic nephrectomy was suggested. The right crossed ectopic kidney appeared fused at its upper pole to the lower pole of the left kidney. The left kidney was in total rotation postero superiorly The left ureter crossing over the ectopic dilated right pelvis deliniated the fusion line between both kidneys. The right ureter was dissected distally. The right artery and vein were dissected and the right kidney pelvis opened making the separation of the kidneys easier and so reducing the danger of damaging the lower pole of the left kidney. During the dissection an aberrant vein arising from the left iliac vein and draining from both kidneys was identified. The right vein was dissected preserving the left vein, and the nephrectomy completed. Conclusions: Laparoscopy is a recommended option to treat CFRE, offering all advantages of this approach. Keywords: Laparoscopic, Nephrectomy, Crossed fused kidney ectopia, Child

The pelvic kidney is the most common type of renal ectopia. It is clinically asymptomatic in general but are more prone to the urinary infections. It has also been associated with an increased risk of nephrolithiasis. The 37-year-old man was admitted to the emergency room with complaints of left flank pain, nausea and vomiting. In addition to this flank pain, the patient had an intermittent pain in the lower abdomen and pelvic region for 6 years with no history of fever. The renal ultrasound demonstrating several shadowing echogenic areas consistent with nephrolithiasis in both kidneys. In addition, while the right kidney was in the normal size and location, the left kidney was located on the ectopic site, just above the bladder. Doppler examination revealed double renal arteries originating from the aorta on the right side. Our case indicates the importance of the ectopic pelvic kidney location when planning surgical procedures in patients with renal and pelvic pathology, kidney transplantation and nephrectomy.

We report a case of a 49-year-old woman with a rare anomaly, intrathoracic renal ectopia. Her medical history includes a surgically corrected congenital diaphragmatic hernia, which can cause late presentations of diaphragmatic hernia in adult life. The Tc-MAG3 renogram demonstrated slower emptying of the dilated pelvis of the ectopic kidney than the normal kidney. The curve confirmed a delayed Tmax, followed by a distinct decline. These features are not indicative of a complete obstruction, but can result from partial obstruction, renal dysfunction with poor response to diuresis, pelvic dilatation (such as in our patient), or a combination.

Crossed renal ectopia with fusion is an extremely rare congenital anomaly with few reported cases of pelviureteric junction obstruction, which often involves the crossed-over kidney. To our knowledge, we describe the second case in literature to report an uncrossed kidney with pelviureteric junction obstruction and giant hydronephrosis, which obstructs the pelviureteric junction of the crossed-over kidney. The grossly hydronephrotic kidney was found to be poorly functioning and an aberrant crossing vessel was considered to be potentially involved, raising both diagnostic and management challenges. By reporting this case, we aim to stress the importance of adequate mapping collecting systems, drainage patterns and vascular supply in such crossed fused anomalies.

A female infant was born at 38+5 weeks in good condition via vaginal delivery. Antenatal ultrasound scans had suggested a left-sided congenital cystic adenomatous malformation. However, a postnatal chest X-ray (figure 1) raised the possibility of congenital diaphragmatic hernia (CDH). Figure 1 Chest X-ray taken at 24 hours of age. Subsequent CT chest (figure 2 …

Rationale: Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. Patient concerns: Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. Diagnoses: On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. Interventions: Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. Outcomes: Two patients have been followed up and have no stones recurrence. Lessons: Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.

The aim of the present study was to summarize the management of upper urinary tract calculi in crossed fused renal ectopia (CFRE). Two patients were retrospectively studied in Xiangya Hospital (Changsha, China) and all relevant literature published in English between 1996 and 2016 was reviewed. All patients, including those reported in the literature, were characterized by age, sex, manifestation, therapy history, ectopic side, stone location, surgery and outcome. The patients had a mean age of 42.3±18.5 years, a male: Female ratio of 5:4 and the ratio of renal ectopic side was 9:8 (left:right). All patients suffered from different degrees of pain on the affected side, with or without hematuria. Up to 89% of patients presented with renal stones. These patients received treatments including conservative management in 2, extracorporeal shock wave lithotripsy (ESWL) in 2, percutaneous nephrolithotomy (PCNL) in 11, laparoscope nephrolithotomy in 1 and retrograde intrarenal surgery (RIRS) in 3. Complete stone clearance was achieved in 14 patients (73.7%). In addition, 3 patients had a history of failed ESWL. No obvious intraoperative or postoperative complications occurred. The results suggested that, for the treatment of CFRE with upper urinary tract calculi, conservative treatment and ESWL are insufficient. PCNL is a safe and effective treatment for renal calculus, and laparoscopic nephrolithotomy is an alternative choice for treating large or staghorn renal stones. RIRS may become the first line of treatment for renal stones (≤3.5 cm) due to its multiple merits, including higher stone-free rates, minimal invasion and fewer complications.

There are three abnormalities of kidney location: simple renal ectopia or pelvic kidney, crossed renal ectopia, and horseshoe kidney. Simple renal ectopia is a kidney that is located on the correct side but in the pelvis, with the adrenal gland filling the renal fossa. With crossed renal ectopia, both kidneys are on the same side; one kidney is in the normal location and the other is located just below the first, with its ureter crossing the midline before inserting into the bladder. Horseshoe kidney indicates fusion of the inferior poles of the kidneys in the midline to form a horseshoe shape. Renal ectopia tends to be more challenging to detect prenatally than other renal abnormalities, particularly horseshoe kidney. Each type of ectopia is associated with increased risk for vesicoureteral reflux and ureteropelvic junction obstruction. Third-trimester evaluation is suggested, even in the absence of renal pelvis dilatation earlier in gestation. There is also a high prevalence of anomalies of other organ systems, and if any associated anomalies are identified, amniocentesis should be offered.

A 40 year old woman had undergone surgery as a newborn due to a left sided congenital Bochdalek hernia with the ventricle, spleen, left kidney and adrenal gland located intrathoracically. After three pregnancies, she developed left sided flank pain and dyspnea. A CT scan showed a diaphragmatic hernia with a malrotated intrathoracic placed left kidney with minimal hydronephrosis. The spleen was located caudally in the left iliac fossa; there were no other abnormalities. The patient underwent a thoracotomy with a small resection of the diaphragm in order to replace the kidney in the abdominal cavity and closure of the diaphragmatic defect with a Gore-Tex patch.

Mullerian duct aplasia–renal agenesis–cervicothoracic somite dysplasia (MURCS) association is a rare and unusual constellation of nonrandom findings that include Mullerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia. The agenesis of the Mullerian duct is the second-most common cause of primary amenorrhea after Turner syndrome. The abnormal development of Mullerian duct often associates with the urinary tract and skeletal abnormalities. MURCS association is a unique and rare developmental disorder with four common features of uterine hypoplasia or aplasia, renal agenesis or ectopy, vertebral anomalies, and short stature. Here, we report a 32-year-old female with aplasia of the Mullerian duct, unilateral renal agenesis, and anomalies of the cervicothoracic somites (MURCS association).

Crossed renal ectopia is a rare congenital malformations where a kidney is located on the side opposite to side of its urethral insertion into the urinary bladder and is generally fused with the normally located ipsilateral kidney Resulting from aberrant migration andcrossing of the midline of the metanephric blastema and ureteral bud CFRE is thought to develop during th to th weeks of gestation Mostly remaining asymptomatic and detected as an incidental finding during imaging studies six well defined anatomical variations of CFRE have been reported We report here one such case of crossed fused renal ectopia detected by usg which was later on confirmed by computed tomography

RESUMEN La asociacion MURCS (Mullerian aplasia, Renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) hace referencia a un conjunto de anomalias congenitas, que sin ser debidas al azar, aparecen de forma concomitante en una persona. Se caracteriza por una aplasia Mulleriana, aplasia renal y displasia cervico-toracica provocadas por alteraciones en los somitas correspondientes, es de etiolo-gia heterogenea. Se presenta el caso de una paciente de 9 anos de edad, que es diagnosticada con la asociacion MURCS, por presentar agenesia uterina, hipoplasia y ectopia renal unilateral y malformacion de la 5ta vertebra cervical. Se enfatiza en la importancia de la busqueda activa de las otras anomalias diferentes a las Mullerianas para lograr el diagnostico y realizar un manejo integral e interdisciplinario.PALABRAS CLAVE: Asociacion MURCS, aplasia Mulleriana, anomalias congenitas,desordenes del desarrollo sexual SUMMARY The MURCS association (Mullerian aplasia, renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) refers to a set of congenital abnormalities, without being due to chance, they appear con-comitantly in a person. It is characterized by Mullerian aplasia, renal aplasia and cervicothoracic dysplasia caused by alterations in the corresponding somites. We describe a case report of a 9-year-old female, who is diagnosed with MURCS association, to present uterine agenesis, hypoplasia and unilateral renal ectopia and deformity of the 5th cervical vertebra. We emphasize the importance of interdisciplinary care, including a clinical geneticist in the care of patients with these characteristics.KEY WORDS

Crossed-fused renal ectopy is an uncommon abnormality of the genitourinary tract that results from errors during embryological development. Ureteral herniation represents another rare anatomic event and can often occur from spontaneous, postoperative, and congenital causes (Allam, Johnson, Grewal & Johnson 2015; Pollack, Popky & Blumberg 1975). Here, we discuss the complex clinical course of a patient with crossed-fused renal ectopia who presents with symptoms due to ureteroinguinal herniation and provide a brief overview of the literature. We highlight the clinical considerations in the management of this patient and provide a potential anatomical and embryological explanation for his presentation.

Wilms' tumor is the most common pediatric solid renal tumor. Cross-fused renal ectopia is a rare congenital anomaly in which the left and right kidneys become fused and fail to ascend from the pelvis and abdomen. We report a case of a 5-year-old girl that underwent open partial nephrectomy on a cross-fused ectopic kidney, "pancake kidney," after incidental discovery of a solid renal mass found to be a Wilms' tumor. Thorough review of the literature shows that this combination of Wilms' tumor in the setting of cross-fused renal ectopia has only been reported twice previously.

Management of renal stone in crossed fused renal ectopia (CFRE) is difficult because of abnormal location, malrotation, and its relations with vertebral column and small bowel. Management is not standardized because of the paucity of literature and variable anatomy. We managed an 8-year-old boy with multiple renal stones in right side crossed kidney by laparoscopic pyelolithotomy and nephro pyeloscopy with the help of ureteroscope. Until now, there is only one prior report of laparoscopic pyelolithotomy in CFRE. We share our experience in this case and review the literature regarding the management of kidney stones in this rare anomaly.

Background. We report the case of a male infant whose right kidney migrated to an ectopic position after birth. The migration of a kidney in postnatal life without any symptoms has not been reported in literature so far.Case Presentation. In a series of antenatal and the first postnatal ultrasound scans, the right kidney was normally located within the right renal fossa. During the first 3 months of life, the kidney migrated to a subdiaphragmatic position. This was confirmed on MRI scan. The infant was asymptomatic with normal renal function and blood pressure.Conclusion. Postnatal migration of a kidney has been described in cases of diaphragmatic hernia or nephroptosis. In this report, we describe a case of kidney migration where there were no underlying anatomical defects to provide an explanation for the kidney migration. This is the first report in literature of a case of postnatal migration of a kidney.

Extra-renal calyces are a rare anomaly of the renal collecting system, characterised by the presence of calyces and pelvis outside the renal parenchyma. It may also be associated with other anomalies, such as renal ectopia, fusion and malrotation. We describe an unusual case of extra-renal calyces with six long calyces arising from a suspected multicystic dysplastic kidney that was successfully managed laparoscopically.

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.

Introduction and Objectives: The pelvic kidney is the most common form of renal ectopia. An anomalous blood supply and a tortuous ureter with high insertion can lead to poor drainage of ur...

Urological anomalies can be seen in children with renal ectopia (RE) and can result in renal impairment. Therefore, we evaluated associated anomalies and renal outcome in our patients with RE. Sixty-eight children who were diagnosed with RE between January 2009-May 2014 were retrospectively studied. A total of 68 patients, 36 (52.9%) boys, with a median age of 67 months (4-201) and a median follow-up period of 14 months (3-113) were included in the study. Simple RE (S-RE) was found in 51 (75%) patients, of which 46 were unilateral and five were bilateral (discoid kidney). Crossed RE (C-RE) was detected in 17 (25%) patients. Voiding cystourethrogram was performed in 21/51 (41.2%) patients in S-RE group and 5/17 (29.4%) in C-RE group. We did not find vesicoureteral reflux (VUR) in any of the patients with C-RE, whereas, in S-RE group, VUR was demonstrated in six (6/21 - 28.6%) patients. Pelviureteric junction obstruction in ectopic kidney was found in two patients with S-RE and one with C-RE. Two patients (2/17 - 11.7%) had neurogenic bladder due to meningomyelocele, accompanied by imperforate anus in C-RE group. There were no significant differences in other associated urological anomalies between two groups. Renal impairment developed mostly in patients with additional urinary anomaly. The children with RE may have associated urinary anomalies, of which VUR is the most common. Complete urological investigation and regular follow-up are required in selected cases.

A woman aged 33 years presented with a 2-week history of non-traumatic back pain, progressive bilateral lower limb weakness with paraesthesia and urinary incontinence. She had a background of recurrent urinary tract infection and hypertension. Clinical examination revealed reduced power bilaterally (grade 3/5) and reduced reflexes but normal tone. She was unable to walk. Abdominal examination was unremarkable and per rectal examination was normal with good anal tone. She was apyrexial with a blood pressure of 132/86 mm Hg and heart rate of 84 bpm. Admission blood tests (including FBC, CRP, U&E, bone profile, magnesium, B12 and folate) were normal. Urine dipstick was also normal. An urgent whole-spine MRI excluded cord compression. It did however reveal a soft tissue mass in the pelvis anterior to the S1 vertebral body, just …

Case summaryThis report describes a rare case of crossed fused renal ectopia (CFRE) in a cat. A mature intact male Persian cat presented with bloody nasal discharge and ascites. Diagnostic studies revealed an ectopic left kidney fused with an orthotopic right kidney and a concurrent feline infectious peritonitis (FIP) infection. The FIP was responsible for clinical signs in this cat, while clinical signs associated with CFRE were not obvious. Despite receiving intensive treatment, the cat died. A post-mortem examination was not performed because the owners declined approval.Relevance and novel informationTo the best of our knowledge, this is the first report of L-shaped CFRE in a cat. In addition, this report describes the CT features of L-shaped CFRE in a cat.

Unilateral crossed renal ectopia without fusion is an uncommon anatomic anomaly, which often goes undiagnosed. We report a case of this renal variant discovered incidentally during colostomy reversal after Hartmann’s procedure for diverticular stricture.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized with the congenital ab- sence of uterus and vagina. Uterus may be rudimentary. Coexistence of a myomauteri with MRKH syndrome is possible. The case presented in this study is the eighteenth report in the literature. Moreover, it is the fi rst one with coexistent skeletal system anomalies, left pelvic renal ectopia, and leiomyoma of the rudimentary uterus. Coexistence of a uterine leiomyoma and MRKH syndrome is very rare. However, if a patient with MRKH syndrome presents with a pelvic mass, the possibility of a leiomyoma should be considered. The review of the english written medical literature revealed that the coexistence of a uterine leiomyoma and MRKH syndrome is very rare. However, if a patient with MRKH syndrome present with a pelvic mass, the possibility of a leiomyoma should be considered.

Clinical Image: A 40 years old without a specific history who presents hypogastric pain associated with urinary signs type dysuria, pollakiuria. Biologically renal impairment with creatinine at 45 mg/l/min, ECBU is negative. Radiologically, abdominal ultrasound objective absence of visualization of the two kidneys with a pelvic renal ectopia is the seat of multiple stones, supplemented by an abdominal CT without injection of contrast product which confirms the presence of a dilation. Kidney laminating the parenchyma on a pancake lithiasic pelvic kidney driving back the bladder in the anterior. After discussion with the patient, an exploratory umbilical laparotomy with possibly nephorolithotomy for the extraction of the stones was proposed but the patient refused the procedure. Pancake kidney is rare and usually asymptomatic. Surgical intervention may be needed at complicated cases. Careful preoperative scrutiny of imaging can guide surgical therapy. More research is needed to establish the standard management of these patients.

Objective: To assess the morphological and clinical features of children with renal ectopia (RE) and assess whether the lateralization of ectopia determines the prognosis. Methods:The clinical, laboratory and radiological data of 61 patients diagnosed as RE in our center between the years of 2004 and 2014 were retrospectively reviewed. Results: There were 32 girls (52.5%) and 48 boys (47.5%). The median age was 48 (2-204) months and follow-up time was 60 (2-120) months. RE was right-sided in 33 (54%) and left-sided in 26 (46%) patients. 52 patients (85.2%) had simple RE whereas 9 (14.8%) had crossed RE. 27 children (44.3%) had additional urinary abnormality, 15 (24.6%) had extra-renal disease. The most common urinary tract malformation was vesicoureteral reflux (VUR) (21%). Renal scarring (RS) was detected in 17 patients (27.9%) on DMSA scan. 32 patients (52.5%) experienced urinary tract infection (UTI), 5 (8.2%) had hypertension, 11 (11%) had proteinuria, 5 (8%) had chronic renal disease (CKD). No significant difference was found between ectopia sides for evelopment of additional urinary or systemic disease, UTI, proteinuria, hypertension and CKD (p> 0.05). Conclusion: The children with RE should be carefully examined for additional urinary or systemic abnormalities. Voiding cystourethrogram might be recommended in those patients for the increased risk of VUR. The patients with RE should be closely followed-up for avoiding long term complications including proteinuria, hypertension and CKD because of susceptibility to UTI and RS. The lateralization of ectopia might not affect the incidence of additional abnormality or late complications.

A 76-year-old Japanese man was transported to our emergency room in summer with a coma and fever. His Glasgow coma scale score was E4V2M4, and his body temperature was 37.8°C. As part of a clinical workup, a pulmonary examination was performed, which revealed reduced breath sounds in the right basal hemithorax. Chest radiography revealed a round lesion on the right inferior lobe (figure 1). Lung tumour or abscess was suspected, but blood examination revealed renal dysfunction; thus, …