case_images: PMC5899298_01
case_images: Noncontrast CT images of a 64-year-old woman with chronically obstructed horseshoe kidney. (a) Noncontrast CT (May 2016) shows left moiety of horseshoe kidney obstructed with staghorn calculus (*), causing massive pyonephrosis (arrows). (b) Marked interval improvement in superior pole pyonephrosis of left moiety of horseshoe kidney status postpercutaneous nephrostomy tube placement (arrow). (c) Persistent severe pyonephrosis (arrows) in interpole and inferior pole of left horseshoe kidney moiety prompted placement of second percutaneous nephrostomy tube.
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case_images: The left moiety had massive caliceal dilation of intermediate density fluid (concerning for pyonephrosis) and thinned parenchyma with perinephric stranding, concerning for xanthogranulomatous pyelonephritis (Fig. 1a). Repeat CT scan 2 weeks later revealed significant decompression of the left moiety upper pole (Fig. 1b), but an undrained area of the lower pole remained (Fig. 1c), which was managed with an additional percutaneous drain.
case_images: Laparoscopic resection of a massively obstructed horseshoe kidney. (a) Four port sites were utilized for laparoscopic dissection of horseshoe kidney. (b) Whole, extracted specimen measured 2670 g and 25.5 x 19 x 10.5 cm.
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case_images: Four port sites were utilized for laparoscopic dissection of the left moiety (Fig. 2a). The massive specimen (Fig. 2b) was extracted through the same low midline incision.