A 69-year-old male presented to the emergency department with periumbilical pain radiating across his abdomen, with associated nausea and emesis. CT abdomen and pelvis with intravenous and oral contrast revealed an obstructing 5 mm ureteral calculus in the right ureterovesical junction causing severe hydroureteronephrosis of the right portion of the patient’s horseshoe kidney, a delayed right nephrogram, and severe right perinephric stranding. Additionally, there was a 1.3 cm ureteral calculus in the left ureterovesical junction, causing moderate hydroureteronephrosis of the left portion of the horseshoe kidney and mild perinephric stranding. There were also bilateral non-obstructing renal calculi in the horseshoe kidney (Figure ).\nWhile the ureteral and renal calculi accounted for the patient’s presenting symptoms of abdominal pain, the CT scan also revealed the horseshoe kidney having an associated anomalous IVC. The IVC had a “circumrenal” course surrounding the horseshoe kidney. The IVC split above the horseshoe kidney at the level of the L1 vertebral body into a pre-isthmic IVC (anterior to the horseshoe kidney) and a posterior IVC (Figure ). Below the kidney, the IVC rejoined at the level of the L5 vertebral body. On sagittal CT imaging, the IVC closely approximates the anterior and posterior aspects of the horseshoe kidney (Figure ). The right gonadal vein was noted to drain into the pre-isthmic IVC. Additionally, the right ureter took a retrocaval course posterior to the pre-isthmic IVC. There was narrowing of the right retrocaval ureter between the horseshoe kidney and the pre-isthmic IVC (Figure ).
This is a 1-month-old male diagnosed with transposition of big vessels, treated with ASA and carvedilol; he was sent to a multispecialty hospital when he was 11 years old. Here, a CT angiogram was donde revealing an ambiguous situs with levocardia, two bilobed lungs, left liver, right stomach, right polysplenia, interruption of the IVC with hemiazygos continuation, four pulmonary veins reached the left atrium, presenting two SVC that reached the RA and IVC interruption with hemiazygos continuation to the left SVC. An ASD was observed, the left atrium communicated with a small and inferiorly situated ventricle, the RA communicated with a larger ventricle of superior situation, with an interventricular communication that can be taken as a single ventricle, transposition of great vessels, the aorta in front of the pulmonary artery. The suprahepatic veins drained directly with a common trunk to the RA. ().\nWith these findings, a pulmonary artery–left vena cava anastomosis was performed; his postoperative course was uneventful and was discharged home.\nFour years later, the patient consulted because of cyanosis, growth retardation and pulse oximetry of 70%; therefore, a second surgery was decided after right SVC ligation pulse oximetry raised to 90%.