Maimuna, a 7-month-old patient, has abnormal lab results including elevated AFP and a large heterogeneous cystic mass arising from the sacral region. Imaging shows a left pelvic teratoma causing hydronephrosis of the left kidney due to PUJ obstruction. The patient has a horseshoe kidney with the left kidney ectopic and fused to the lower pole of the right kidney. A percutaneous nephrostomy was performed to drain urine from the left kidney.

2. Maimuna,
7 months
NP-06

3.  CBC – Hb% - 11.3 g/dl
WBC – 15700/cumm
Platelet –4.35
lakh/cumm
 AFP – 29.56 ng/ml (upto 13.6
ng/ml)

 B- HCG– 0.5782 mIU/ml (0.3 -
6.45 mIU/ml)
 S. Creatinine- 0.38 g/dl
 Urine R/M/E - pus cell : 4-6 /HPF,
epithelial cell : 1-3/ HPF, RBC -
nil.

4.  A fairly large mixed intensity,
predominantly cystic
mass(14.7×6.1×6.1)cm noted in
sacrococcygeal region. The lesion has
presacral intrapelvic component with
large external component. Lower
pole of both kidney seems to be
fused. Pelvicalyceal system of left
kidney is grossly dilated.
 Comment : Suggestive of
sacrococcygeal teratoma with?
Horseshoe kidney with left sided
gross hydronephrosis.

5. 1. No vesico ureteric reflux seen
2. Cystogram & urethrogram are normal
3. No significant post voidal residue present
4. Large soft opacity in left lower gluteal region
present

6.  Pelvi calyceal system of left kidney is
markedly dilated. Abrupt narrowing in
pelvi ureteric Junction.
 Left renal parenchymal thickness is
reduced.
 A fairly large mixed density lesion (14cm
×5 cm) seen in lower pelvis at presacral
subsacral location. The lesion has cystic,
fatty & solid components.
 Comment:
 Left pelvi ureteric Junction obstruction
with severe left hydronephrosis &
obstructive uropathy
 Suggestive of pelvic teratoma.

8. Comment : A large
heterogenous
complex mass
(predominantly
cystic) arising from
sacral region.
Left sided gross
hydronephrosis- PUJ
obstruction.

9.  Split function :
 Left kidney - 01%
 Right kidney - 99%
 GFR :
 Right kidney - 79.7 ml/min
 Left kidney - Nil
 Impression :
 Left kidney - Non visualized
 Right kidney - normal
function

10. Normal study

11. Per cutaneous
nephrostomy on left
side done on
25/07/2022
Approximately 20 ml
of urine is drawn.

12.  Split function :
 Left kidney - 28%, Right kidney - 72%
 GFR :
 Left kidney - 21.3 ml/min
 Right kidney - 55..7 ml/min
 This is a case of cross fused ectopia. Left renal
bed is empty. Left kidney is ectopic in position
fused with lower pole of right kidney.
 Impression :
 Left kidney - ectopic in position with pelvi
calyceal dilatation showing no obstruction
with moderate parenchymal impairment
 Right kidney - normal function