Rare case of associated congenital anomalies--ectopic left kidney with pelvic presentation and descending thoracic aorta coarctation

Abstract

We present the case of a patient with extremely rare associated congenital anomalies: thoracic aorta coarctation and left ectopic kidney with pelvic presentation. A 45-year-old male patient was admitted to our institution for multidetector computed tomography (MDCT) angiography. On admission, he complained of intermittent claudication after 10 meters of walking, frequent chest pain, and hypertension crisis. Femoral pulse was absent in the left leg. At 14 years of age, he underwent insertion of a 10-mm Dacron tubular graft at the descending aorta level for isthmic coarctation. MDCT arteriography revealed significant stenosis (>90%) at the proximal anastomosis site of a previous graft in the form of a floating thrombus (pseudocoarctation‒re-coarctation) as well as an ectopic pelvic left kidney with the left renal and accessory renal artery arising from the left common iliac artery. One year ago we attempted percutaneous angioplasty of the aforementioned in-graft stenosis. At the time, the procedure was partly successful and the patient had been doing well, but all of the aforementioned symptoms reappeared and CT angiography showed no signs of improvement. Therefore, ascending-to-descending aortic bypass was done with an 18-mm Dacron tubular graft with preserved postoperative renal function and palpable peripheral pulses. MDCT angiography showed normal postoperative findings and the patient was doing well. In the case presented, MDCT angiography played a significant role in this rare aortic anomaly detection with incidental discovery of a rare developmental kidney complication.