Location
Suwanee, GA
Start Date
7-5-2024 1:00 PM
End Date
7-5-2024 4:00 PM
Description
Introduction:
Case report of a horseshoe kidney found in a 62-year-old deceased male during routine cadaveric dissection at PCOM Georgia College of Osteopathic Medicine. Horseshoe kidneys occur in 1:500 individuals.
Methods:
Horseshoe kidney pathology was observed in the medical school gross anatomy laboratory during routine dissection. Specifics about the case were noted and photographed with permission from the donor and university.
Results:
While most horseshoe kidney cases are asymptomatic, no data is present to determine whether kidney symptoms were present in this specific case. The man died of a middle cerebral artery stroke that is unrelated to the kidney pathology.
Most horseshoe kidneys are located lower in the abdomen than normal kidneys. In this case, the horseshoe kidney was significantly lower in the abdomen. It was located at the midline immediately below the branching of the inferior mesenteric artery and covered the bifurcation of the common iliac arteries.
Ureters exited at the anterior border of the kidney and transversed over the anterior surface of the kidney to reach the bladder. Concave invaginations surrounded the exit of the ureters, raising concerns about potential renal obstructions or hydronephrosis that could have occurred during the man’s life. A small cyst was also observed on the left lower pole of the kidney. While some common pathology was observed, the overall structure of the kidney appeared in good health, indicating that the case subject was not likely to have had significant renal symptoms throughout his life.
The left renal artery exited the aorta at L1/L2 and entered the kidney at the left superior pole of the kidney. The right renal artery exited the aorta near the common iliac bifurcation and entered the kidney at the anterior/superior right aspect of the kidney. Both renal veins exited the kidney at the right/left anterior polls of the kidney and drained directly into the inferior vena cava. The right renal vein entered the inferior vena cava at the L1/L2 level. The left renal vein entered near L4.
Discussion:
While most horseshoe kidney cases are asymptomatic, the unique anatomy and convoluted routes of the ureters may make complications such as vesicoureteral reflux and nephrolithiasis more common in these individuals. Whether these symptoms occur during a patient’s lifespan, the unique anatomy would present challenges during abdominal surgery or other abdominopelvic cavity procedures.
While our case was a male, females with horseshoe kidneys can have complications associated with pregnancy (as the fetus presses on the kidney, ureters, and vessels traversing the enlarged midline structure).
Conclusions:
This case underscores the importance of clinicians understanding the anatomical variations associated with horseshoe kidney cases. Care and special planning should be taken when considering these variations during abdominal or pelvic procedures.
Embargo Period
12-12-2024
Included in
Case Study of a Horseshoe Kidney
Suwanee, GA
Introduction:
Case report of a horseshoe kidney found in a 62-year-old deceased male during routine cadaveric dissection at PCOM Georgia College of Osteopathic Medicine. Horseshoe kidneys occur in 1:500 individuals.
Methods:
Horseshoe kidney pathology was observed in the medical school gross anatomy laboratory during routine dissection. Specifics about the case were noted and photographed with permission from the donor and university.
Results:
While most horseshoe kidney cases are asymptomatic, no data is present to determine whether kidney symptoms were present in this specific case. The man died of a middle cerebral artery stroke that is unrelated to the kidney pathology.
Most horseshoe kidneys are located lower in the abdomen than normal kidneys. In this case, the horseshoe kidney was significantly lower in the abdomen. It was located at the midline immediately below the branching of the inferior mesenteric artery and covered the bifurcation of the common iliac arteries.
Ureters exited at the anterior border of the kidney and transversed over the anterior surface of the kidney to reach the bladder. Concave invaginations surrounded the exit of the ureters, raising concerns about potential renal obstructions or hydronephrosis that could have occurred during the man’s life. A small cyst was also observed on the left lower pole of the kidney. While some common pathology was observed, the overall structure of the kidney appeared in good health, indicating that the case subject was not likely to have had significant renal symptoms throughout his life.
The left renal artery exited the aorta at L1/L2 and entered the kidney at the left superior pole of the kidney. The right renal artery exited the aorta near the common iliac bifurcation and entered the kidney at the anterior/superior right aspect of the kidney. Both renal veins exited the kidney at the right/left anterior polls of the kidney and drained directly into the inferior vena cava. The right renal vein entered the inferior vena cava at the L1/L2 level. The left renal vein entered near L4.
Discussion:
While most horseshoe kidney cases are asymptomatic, the unique anatomy and convoluted routes of the ureters may make complications such as vesicoureteral reflux and nephrolithiasis more common in these individuals. Whether these symptoms occur during a patient’s lifespan, the unique anatomy would present challenges during abdominal surgery or other abdominopelvic cavity procedures.
While our case was a male, females with horseshoe kidneys can have complications associated with pregnancy (as the fetus presses on the kidney, ureters, and vessels traversing the enlarged midline structure).
Conclusions:
This case underscores the importance of clinicians understanding the anatomical variations associated with horseshoe kidney cases. Care and special planning should be taken when considering these variations during abdominal or pelvic procedures.