Contralateral

Renal

Herniation

after

of Pseudo-Crossed

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KYUNG

Crossed ally

renal

ectopia

congenital

acquired by a

[i].

due large

is an uncommon Rarely,

crossed

to contralateral retroperitoneal

pseudo-crossed [2]. We report renal ectopia thoracoabdominal

the

JOSEPH

anomaly, renal

by case

F. WALTER,2

may

She was

and

Report

A 36-year-old obese woman weighing 1 66 kg had a left radical nephrectomy for hypennephnoma. Peniaortic node dissection, splenectomy, and adnenabectomy were also performed by the thoracoabdominal approach. An intravenous pyelogram and renal arteniognam done at a local hospital had demonstrated a large vascular mass in the upper pole of the left kidney. The kidney

was

normal.

Hemoglobin

was

15 g/iOO

ml;

the

1.-A,

arteries

Abdominal

stretched

demonstrating Received

3

she

examination

a left

to the

syndrome

and

ml.

revealed

thonacoabdominal

readmitted

2 mg/100

pain.

showed The

right

The

of

later serum

proteinunia kidney

bowel

hernia

2 years

flank

Urinalysis

evidence incisional

hospital

left

in a 24 hr collection.

renal

across

aortognam

midline

normal-appearing May 23, 1977;

Department Department Department

Am J Ro.ntgenol

accepted

showing

to night

aorta

kidney

night kidney after

displaced

in left

flank

was

sac.

because with

not

of

creatinine

3 g of

visualized

left

left

upper

quadrant

patient’s

demonstrating intestine

a large and

right

was

that displaced

incisionab renal

venogram

herniation

hernia

of

(arrow).

upper

renal

problems herniation

abdominal

B, Selective

viscera

injection

and

massive

was

not

August

1977

the into

hernia

(fig.

showed

obesity,

(open arrows). Note two right renal into larger of two right renal arteries

12, 1977.

i 099

Address

reprint

surgical

attempted.

lying lateral to left rib cage.

revision

December

small

through

pulmonary of the

of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan 48109. of Radiology, Palo Alto Medical Clinic, Palo Alto, California 94301. of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109. 129:1099-1100,

performed,

of the

infeniorvenacavogram

correction

by

were

much

and torsion of the right renal vein (fig. 2). There Hg pressure gradient between the renal vein and the inferior vena cava, presumably secondary to the torsion. It was thought that the proteinunia and mildly elevated creatinine were caused by the partially obstructed renal vein. Because of the

incisional

and

a

displacement was a 5 mm

hema-

to

arteniogram

kidney

1). An

tocnit, 47%; and creatinine, 0.8 mg/iOO ml. The hypennephroma was confined to the kidney. The postoperative course was

2

was

protein

right

‘

into

and dehiscence which gradupatient did well until 7 months experienced sudden sharp pain in her

on an intravenous pyelognam with nephnotomognams. Since neoplasm of the remaining kidney was suspected, an aortogram Case

Fig.

when Physical

Pickwickian

radical carci-

W. KONNAK3

by wound infection by granulation. The

flank.

herniation

noma.

right

JOHN

surgery,

left

and Bryk crossed

kidney after a for renal cell

AND

after

A Cause

Ectopia

complicated ally healed

be

of a kidney was termed

Greenspan of acquired

remaining nephrectomy

Renal

gener-

ectopia

displacement mass. This

renal ectopia an unusual of

J. CHO,’

Nephrectomy:

requests

to K. J. Cho.

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1100

CASE

Fig.

2.-A,

Inferior

venacavogram B, Right renal

left tenth rib (arrow). cava (arrowhead).

showing venogram

displaced revealing

REPORTS

and twisted inferior patent renal vein.

vena cava Mild torsion

The

Discussion Both been the

intraperitoneal known

opposite

to side

ally

retroperitoneal

a kidney

of the

Bryk [2], reporting pia produced by reports of such ing an operation

and

displace

abdomen

a case a barge

into

an

the

[2-4].

ipsilateral

have

spine

into

Greenspan

of pseudo-crossed retropenitoneal

cases. Herniation on the kidney,

displaced

masses

across

and

renal ectocyst, found 35

usually and the

occurs kidney

hernia

sac

and kidney angiographic

had

herniated. study in our

patient

was

gradient

between

cava

offered

a possible

and elevated

creatinine.

the

renal

explanation

vein

and for

[5].

In our

helpful

inferior the

may

in

vena

proteinuria

kidney is herniated of right renal vein

move

in all

the spine, with or the entire abdomen pyebogram

fails

directions,

without should

to

through

(arrow)

bed

of resected

and inferior

even

vena

medially

previous surgery [6]. be searched when a

show

the

kidney

in

the

ex-

location.

REFERENCES

demonstrating why the kidney was not seen; it had herniated outside the abdomen and was not included on the nephrotomograms. Also, the establishment of a pressure

kidney

routine pected

Right at origin

is present

followis gener-

case the kidney was displaced contralateralby across the spine into the left flank hernia sac. This unusual type of renal displacement was attributed to the patient’s massive obesity and large incisional hernia into which both bowel The

across Thus

(open arrow).

1.

Emmett Saunders,

JL,

Witten

DM:

Clinical

Urography.

Philadelphia,

1971

2. Greenspan A, Bryk D: Pseudo-crossed renal ectopia. J Can Assoc Radio! 24 :321-322, 1973 3. Woesner ME, Lang DW, Selvaggi FP: Contralateral displacement of the kidney by solitary renal cyst. Am J Roentgenol 116:766-772, 1972 4. Forde WJ, Ostrolenk DG, Finby N: Renal displacement associated with enlargement of spleen. Am J Roentgenol 84:889-897, 1960 5. Ney C, Fniedenberg AM: Radiographic Atlas of the Genitourinary System. Philadelphia, Lippincott, 1966 6.

Prather syndrome.

GC:

Medial

N EngI

ptosis

J Med

of

the

238:253-257,

kidney. 1948

A

new

renal