2010-10-25-11 Pelvic kidney, 3 cases © Cerekja www.TheFetus.net
Pelvic kidney, 3 cases
* Ultrasound Division, ASL Roma B, Rome, Italy.
Ectopic kidney is relatively common finding with it's incidence around 10:10,000. The pelvic kidney represents the most common form of the ectopic kidney. It may be associated with other congenital anomalies, particularly those of the genitourinary, heart or skeletal systems.
This condition results from a failure of the kidney to ascend and rotate during the organogenesis. Normally, as the kidney ascends, new blood vessels arise from the iliac artery, the distal aorta and, finally, the upper abdominal aorta. The ectopic kidneys often maintain the fetal blood supply from the iliac vessels or the distal aorta. The blood supply from both the right and left side appears to be related to the medial position of the pelvic kidney.
Case report 1
A-28-year old patient primigravida, with non-contributive history, was referred to our center at 22 weeks of gestation. Our ultrasound examination showed the left kidney in the normal location with a left renal artery arising from the aorta. The right kidney was located in the bony pelvis, posterior to the urinary bladder, between the iliac vessels.
The right renal artery was arising from the right common iliac artery. There were no other anomalies detected.
Images 1,2: Images show left kidney in the normal location.
Images 3,4: Left renal artery arising from the aorta, right renal artery is not detected in the typical location.
Images 5,6: Right kidney located in the bony pelvis (arrow).
Images 7,8: Iliac arteries, the right renal artery is arising from the right common iliac artery (green arrow). Pelvic kidney is located between iliac vessels.
Case report 2
This is a case of a 33-year-old G1 P0 with non-contributive history. She had a dichorionic-diamniotic twin pregnancy and was scanned at our center at 20 weeks gestation. The ultrasound scan at the lumbar level of the male twin, detected only the right kidney in it's common location. Only a right renal artery arose from the abdominal aorta. The left kidney was detected in the pelvis, just above the urinary bladder, between the iliac vessels. The renal artery of the pelvic kidney arose from the contralateral (right) common iliac artery. No other anomalies were detected.
Images 1,2: Image 1 shows a right renal artery arising from the abdominal aorta. Images 2 shows a transverse view of the abdomen showing the right kidney in the normal location, left kidney is not visible.
Images 3,4: Images show left kidney located in the pelvis, behind the urinary bladder and between the iliac vessels.
Images 5,6: Renal artery for the left kidney is arising from the contralateral (right) common iliac artery (arrow).
Case report 3
A-29-year old woman G1 P0 with non-contributive history was scanned at 18 weeks of pregnancy.
The transverse scan at lumbar level detected only the left kidney in its normal location. Coronal section of the fetal abdomen showed only the left renal artery arising from the abdominal aorta.
The right kidney was visualized in the bony pelvis, medially and above the bladder. The scan was repeated at 20 weeks and confirmed the previous findings. Right ectopic kidney was supplied by a renal artery arising from the left common iliac artery. No other anomalies were evidenced.
The patient was scanned again at 32 weeks of gestation. There was no sign of hydronephrosis and normal amount of the amniotic fluid.
The patient delivered at 39 weeks, a healthy male, 3260 grams, Apgar 9/9 (in 1st/5th minute). Postnatal examination confirmed the ultrasound findings and did not reveal any changes in renal parenchyma. No additional findings were detected.
Images 1,2: Coronal view of the abdomen, images show left renal artery arising from the abdominal aorta. Right renal artery is missing in the typical location. Renal artery for the pelvic kidney (*) arises from the left common illiac artery.
Images 3,4: Image 3 shows a transverse view of the pelvic kidney located in the bony pelvis. Parasagittal view of the abdomen showing the right ectopic kidney located just above the urinary bladder.