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A 5 year old boy was referred to our paediatric ward with fever, headache, and vomiting. Clinical examination elicited tenderness over both flanks and a renal ultrasound was performed. A mass extending over the midline compatible with the diagnosis of a crossed fused ectopic left kidney was noted (arrows, fig 1). A technetium-DMSA scan revealed a normally located and sized right kidney with small horizontal left kidney connected to its lower pole (arrows, fig 2). Renal SPECT showed absorption of 20% in the right and 5% in the left kidney.
A crossed fused renal ectopia is an entity where one kidney crosses over to the other side and the parenchyma of the two kidneys fuse. In most cases it involves the left kidney, as in our patient. Renal function is usually normal. Other anomalies associated with this condition are the VACTER syndrome, hydronephrosis, annular pancreas, and multicystic dysplasia. Most cases are sporadic but dominant inheritance has been reported.