Incidentally detected pancake kidney: a case report
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A 12-year-old Bengali girl with no significant previous medical or surgical history, presented with a chief complaint of mild, dull aching, lower abdominal pain, and dysuria for the last 7 days. She denied any history of fever, hematuria, menstrual abnormality, pelvic inflammatory disease, or trauma. A physical examination revealed a normotensive girl with body mass index (BMI) of 19.5, without any significant finding. Her respiratory system and abdominal examination were unremarkable. Her abdomen was scaphoid with umbilicus in the normal position. No intra-abdominal mass was noticed. There was normal bowel sound with no abdominal or renal angle tenderness. There was neither shifting dullness nor any guarding of abdominal muscles.

The microscopic examination of urine showed traces of albumin and 10–12 pus cells/high-power field (HPF) without any red blood cells. She had a normal kidney function test but confusion started when a digital X-ray of her kidney, ureter, and bladder (KUB) region failed to demonstrate bilateral renal tissue shadows. It showed no KUB region calculus also. An ultrasonographic scan of her whole abdomen also added to the pre-existing confusion by revealing no abnormality of intra-abdominal organs except empty bilateral renal fossa. Ultrasonography (USG) also failed to trace any of the unascended kidneys in bilateral para-vertebral regions in that otherwise healthy girl. Finally, an abdominopelvic multi-detector computed tomography (MDCT) scan showed one round-shaped mass measuring approximately 9 cm (vertical) × 10 cm (horizontal), situated in front of the sacral promontory in the pelvic cavity. That mass was finally identified as two ectopic kidneys malrotated posterolaterally and fused together in the medial aspect in the midline anterior to the third, fourth, and fifth lumbar vertebra (L3–L5, below the bifurcation of abdominal aorta) giving rise to a pancake kidney. The corticomedullary differentiation was maintained. The parenchymal enhancement pattern was normal with excretion of contrast material, which was seen bilaterally. There was no evidence of calculus, obstruction, or hydronephrosis. Short, uncrossed, non-dilated ureters were seen, anterior to renal mass, draining separately into the urinary bladder. MDCT clearly showed both the vascular supply and urinary tract anatomy.

She was prescribed antibiotics based on urine culture and sensitivity test that cured her symptoms (fever and dysuria). Although no follow-up guideline is available in the literature, she was advised to follow-up regularly in urology out-patient department to evaluate her kidney function (to be done yearly if asymptomatic) and to rule out any neoplastic change (by routine ultrasonographic scan yearly if asymptomatic and by MDCT if any symptom arises).

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02455-0
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