This document discusses various congenital anomalies of the kidney and urinary tract that were identified on a CT scan of a 32-year-old female patient presenting with vague lower abdominal pain. It describes anomalies including crossed renal ectopia, horseshoe kidney, fusion anomalies, and anomalies of the renal vasculature, calyces, pelvis and collecting system. It provides details on the embryology, clinical presentation, investigations and management of some of these conditions.

1. IMAGING OF THE WEEKPROF.Dr.RAMASAMY’s UNITDr.K.SENTHAMIZHSELVAN

2. 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

5. 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

7. ANOMALIES OF ASCENT

8. ANOMALIES OF RENAL VASCULATURE

9. ANOMALIES OF FORM AND FUSION

10. ANOMALIES OF ROTATION

11. Anomalies of collecting system CALYX & INFUNDIBULUM; 1.CALYCEAL DIVERTICULUM 2.HYDROCALYX 3.MEGACALYX 4.UNIPAPILLARY KIDNEY 5.EXTRARENAL CALYX 6.PSEUDO TUMOR KIDNEY 7.INFUNDIBULOPELVIC DYSGENESIS PELVIS 1.EXTRA RENAL PELVIS 2.BIFID PELVIS

12. 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

13. 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

14. TYPES OF CROSSED ECTOPIA

15. Proximal kidney normal;distal kidney from opposite side crosses &fuses;both pelvis anterior ,ureters cross

16. Crossed kidney is inferior ;fusion occurs late;pelvis in opposite direction ;

17. Extensive union ; Ureters don’t cross

18. Tandem kidney;crossed kidney assumes transverse position; Both pelvis anterior ;

19. Doughnut kidney or pancake kidney; Pelvis anterior ;ureters uncrossed ;

20. Rarest ;both pelvis anterior

21. 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

22. ASSOCIATED ANOMALIES CROSSED SOLITARY -HEMITRIGONE ECTOPIA POORLY DEVELOPED TRIGONE CROSSED KIDNEY-ECTOPIC URETERAL ORIFICE,CYSTIC DYSPLASIA,PUJ.OBSTRUCTION,CARCINOMA UNCROSSED KIDNEY-ECTOPIC URETEROCELE VUR IMPERFORATE ANUS VERTEBRAL ANOMALIES

23. CLINICAL FEATURES ASYMPTOMATIC VAGUE LOWER ABD.PAIN HAEMATURIA ,PYURIA ,UTI ABDOMINAL MASS HYDRONEPHROSIS RENAL CALICULI HYPERTENSION(DUE TO VASCULAR LESION IN ANOMALOUS VESSELS) INCREASED RISK OF TRAUMA

24. INVESTIGATIONS&TREATMENT BASELINE INVESTIGATIONS TREATMENT IVU - SYMPTOMATIC ; MCU - NEPHRECTOMY USG ABDOMEN CT ABDOMEN RADIONUCLIDE STUDIES CYSTOSCOPY RENAL ANGIO MRI

25. HORSE SHOE KIDNEY TWO DISTINCT RENAL MASS,VERTICALLY ORIENTED, ON EITHER SIDE OF MIDLINE, CONNECTED AT THEIR POLES MOST COMMON RENAL FUSION ANOMALY INCIDENCE 1 :400 MALE PREPONDERANCE 2:1 EMBRYOLOGY---AT 4 WEEKS, SLIGHT ALTERATION OF VASCULAR MORPHOLOGY LEADS TO FUSION ---POST.NEPHROGENIC CELLS MIGRATE ABNORMALLY ,TO FORM AN ISTHMUS BETWEEN THE KIDNEYS

26. BOTH THE PELVIS ARE ANTERIOR INDICATING MALROTATION INFERIOR MESENTERIC ARTERY PREVENTS ASCENT 95%-INFERIOR POLE FUSION 5%-SUPERIOR POLE FUSION ISTHMUS –PARENCHYMA _ FIBROUS BLOOD SUPPLY –BIL.MULTIPLE RENAL ARTERIES ISTHMUS-BR.OF RENAL A. /ABD.A/IMA/ILIAC A.

27. CLINICAL FEATURES 50% ASYMPTOMATIC LIFELONG 50% PRESENT AT LATER AGE VAGUE ABDOMINAL PAIN UTI,RENAL CALCULUS PUJ OBSTRUCTION HYDRONEPHROSIS ROVSING ‘S SIGN CARCINOMA-50%RCC,REST WILM’S ,RENAL PELVIC TUMORS

28. ASSOCIATED ANOMALIES VSD , NEURAL TUBE DEFECTS ANO RECTAL MALFORMATION GENITO URINARY ANOMALIES –HYPOSPADIAS, UNDESCENDED TESTIS,BICORNUATE UTERUS SEPTATE VAGINA,URETERAL DUPLICATION MULTICYSTIC DYSPLASIA,HIGH INSERTION OF URETER METABOLIC –HYPERCALCIURIA ,HYPEROXALURIA, HYPOCITRATURIA SYNDROMES –TURNER, EDWARD &TOWNE BROCK

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