Images in Clinical Urology A New Subtype of Crossed Fused Ectopia of the Kidneys Zhuo Yin, J. R. Yang, Y. B. Wei, K. Q. Zhou, and B. Yan Crossed fused renal ectopia is a rare congenital anomaly; here, we report a new subtype of crossed fused renal ectopia associated with the retroiliac megaureter and thoracic scoliosis deformity. It is beyond the traditional classification of crossed fused renal ectopia. There are 2 kidneys in the left and hydronephrosis of the upper kidney, the right kidney crossed over and fused with the lower kidney of the left. It is never seen in previous reports. Recurrent infection was cured by resecting the hydronephrosis of the upper kidney and retroiliac megaureter. UROLOGY 84: e27, 2014. 2014 Elsevier Inc.
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23-year-old man was referred to the urology clinic for frequent urinary tract infection since childhood. He underwent computer tomography urography and retrograde ureteropyelography (Figs. 1-3). Complete blood count and urinalysis showed infection. The imaging revealed a new subtype of crossed fused ectopia of the kidneys associated with retroiliac ectopia of the megaureter. No special family history was found. Fusion anomalies of the kidneys are divided into crossed fused ectopia (CFE) and horseshoe kidney; the frequency of CFE is 1 in 1000-7500.1 More than half of the patients with CFE have other urogenital, gastrointestinal, cardiopulmonary, chromosomal, or skeletal anomalies.2 CFE may be associated with symptoms related to infection, obstruction, and urolithiasis.3 There are 6 subtypes of CFE mentioned in the previous classification: (1) inferior ectopia, (2) sigmoid or S-shaped kidney, (3) lump kidney, (4) L-shaped kidney, (5) disc kidney, and (6) superior ectopia.4 This case shows a new subtype; there are 2 kidneys in one side, hydronephrosis of the upper kidney, and with retroiliac megaureter (Figs. 1, 2); the contralateral kidney crossed the middle line and fused with the lower kidney (Figs. 1, 3). There is no need to separate the fusion of kidneys.
Figure 1. Crossed fused kidney and hydronephrosis of the upper kidney.
Figure 2. Megaureter behind iliac artery.
References 1. Glodny B, Petersen J, Hofmann KJ, et al. Kidney fusion anomalies revisited: clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney. BJU Int. 2009;103:224-235. 2. Bhatt K, Herts BR. Crossed fused renal ectopia. J Urol. 2014;191: 475-476. 3. Chung SD, Chueh SC, Chiang HS, Liao CH. L-shaped cross-fused kidney with stone. Urology. 2009;73:61-62. 4. Bhatnagar V, Gupta A, Kumar R, Solanki S. Crossed fused renal ectopia: challenges in diagnosis and management. J Indian Assoc Pediatr Surg. 2013;18:7-10. Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China Address correspondence to: Jinrui Yang, M.D., Department of Urology, Second Xiangya Hospital of Central South University, Renmin Road, No. 139, Changsha, Hunan 410011, China. E-mail: [email protected] Submitted: July 7, 2014, accepted (with revisions): August 18, 2014
ª 2014 Elsevier Inc. All Rights Reserved
Figure 3. “Y” type fused ureter of fused kidney. http://dx.doi.org/10.1016/j.urology.2014.08.011 0090-4295/14
e27
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23-year-old man was referred to the urology clinic for frequent urinary tract infection since childhood. He underwent computer tomography urography and retrograde ureteropyelography (Figs. 1-3). Complete blood count and urinalysis showed infection. The imaging revealed a new subtype of crossed fused ectopia of the kidneys associated with retroiliac ectopia of the megaureter. No special family history was found. Fusion anomalies of the kidneys are divided into crossed fused ectopia (CFE) and horseshoe kidney; the frequency of CFE is 1 in 1000-7500.1 More than half of the patients with CFE have other urogenital, gastrointestinal, cardiopulmonary, chromosomal, or skeletal anomalies.2 CFE may be associated with symptoms related to infection, obstruction, and urolithiasis.3 There are 6 subtypes of CFE mentioned in the previous classification: (1) inferior ectopia, (2) sigmoid or S-shaped kidney, (3) lump kidney, (4) L-shaped kidney, (5) disc kidney, and (6) superior ectopia.4 This case shows a new subtype; there are 2 kidneys in one side, hydronephrosis of the upper kidney, and with retroiliac megaureter (Figs. 1, 2); the contralateral kidney crossed the middle line and fused with the lower kidney (Figs. 1, 3). There is no need to separate the fusion of kidneys.
Figure 1. Crossed fused kidney and hydronephrosis of the upper kidney.
Figure 2. Megaureter behind iliac artery.
References 1. Glodny B, Petersen J, Hofmann KJ, et al. Kidney fusion anomalies revisited: clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney. BJU Int. 2009;103:224-235. 2. Bhatt K, Herts BR. Crossed fused renal ectopia. J Urol. 2014;191: 475-476. 3. Chung SD, Chueh SC, Chiang HS, Liao CH. L-shaped cross-fused kidney with stone. Urology. 2009;73:61-62. 4. Bhatnagar V, Gupta A, Kumar R, Solanki S. Crossed fused renal ectopia: challenges in diagnosis and management. J Indian Assoc Pediatr Surg. 2013;18:7-10. Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China Address correspondence to: Jinrui Yang, M.D., Department of Urology, Second Xiangya Hospital of Central South University, Renmin Road, No. 139, Changsha, Hunan 410011, China. E-mail: [email protected] Submitted: July 7, 2014, accepted (with revisions): August 18, 2014
ª 2014 Elsevier Inc. All Rights Reserved
Figure 3. “Y” type fused ureter of fused kidney. http://dx.doi.org/10.1016/j.urology.2014.08.011 0090-4295/14
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