Axial T1 and T2 weighted lumbar spine images are included.
1. What finding is true:
a. Tethered cord
b. Laminectomy
c. Horseshoe kidney
d. Post cholecystectomy
The spinal cord terminates at a normal position, no laminectomy has been performed, and the gallbladder is partially visualized on the most cephalad T2 weighted images included. There is union between the lower poles of the right and left kidney at the midline. Therefore the correct answer is:
c - Horseshoe kidney
2. A horsehoe kidney increases a patient's risk for which of the following:
a. Renal obstruction
b. Pyelonephritis
c. Renal calculi
d. Renal neoplasm
e. All of the above
A horseshoe kidney represent a somewhat common (~1:500 people) congenital/developmental anomaly of the kidney, is most often asymptomatic, and is usually found incidentally on imaging. The change in alignment of the kidneys can lead to urinary stasis producing obstruction of the kidneys. Stasis and higher risk for ureterovesicular reflux increase the likelihood a patient with a horseshoe kidney develops an infection (pyelonephritis) and renal stones. There is also an increased risk for developing tumors, including transitional cell, Wilm's, and carcinoid tumors. Therefore the correct response is:
e - All of the above
Symphysiotomy is a surgical procedure once performed to separate a horseshoe kidney and has been essentially fallen out of use due to limited benefit to the patient and increased surgical complications. Patients with a horseshoe kidney may have associated vascular anomalies or the anomaly may only be a part of a larger congenital dysplasia and these patients may require additioanl imaging prior to surgery or other intervention. Current treatment methods are centered on addressing the complications if and when they arise.
Here is another example of an incidental horseshoe kidney in a 69 year old male patient presenting to the emergency department with abdominal pain. The horseshoe kidney is normal in this patient with no evidence of obstruction, stone, mass, or infection. However, there is a right psoas collection consistent with a psoas abscess that also demonstrates some extension into the iliacus.
1. What finding is true:
a. Tethered cord
b. Laminectomy
c. Horseshoe kidney
d. Post cholecystectomy
The spinal cord terminates at a normal position, no laminectomy has been performed, and the gallbladder is partially visualized on the most cephalad T2 weighted images included. There is union between the lower poles of the right and left kidney at the midline. Therefore the correct answer is:
c - Horseshoe kidney
2. A horsehoe kidney increases a patient's risk for which of the following:
a. Renal obstruction
b. Pyelonephritis
c. Renal calculi
d. Renal neoplasm
e. All of the above
A horseshoe kidney represent a somewhat common (~1:500 people) congenital/developmental anomaly of the kidney, is most often asymptomatic, and is usually found incidentally on imaging. The change in alignment of the kidneys can lead to urinary stasis producing obstruction of the kidneys. Stasis and higher risk for ureterovesicular reflux increase the likelihood a patient with a horseshoe kidney develops an infection (pyelonephritis) and renal stones. There is also an increased risk for developing tumors, including transitional cell, Wilm's, and carcinoid tumors. Therefore the correct response is:
e - All of the above
Symphysiotomy is a surgical procedure once performed to separate a horseshoe kidney and has been essentially fallen out of use due to limited benefit to the patient and increased surgical complications. Patients with a horseshoe kidney may have associated vascular anomalies or the anomaly may only be a part of a larger congenital dysplasia and these patients may require additioanl imaging prior to surgery or other intervention. Current treatment methods are centered on addressing the complications if and when they arise.
Here is another example of an incidental horseshoe kidney in a 69 year old male patient presenting to the emergency department with abdominal pain. The horseshoe kidney is normal in this patient with no evidence of obstruction, stone, mass, or infection. However, there is a right psoas collection consistent with a psoas abscess that also demonstrates some extension into the iliacus.