A case report of diagnosis of functioning ectopic left kidney by DTPA and DMSA renogram failed by anatomical imaging:

DR.SHAMRUKH KHAN1 , Dr. Mehedi Masud1, Dr. Mollah Abdul Wahab2
Clinical Assistant, Nuclear Medicine Department, UHL.  
Consultant , Nuclear Medicine Department, UHL. 

A male baby was born on 05.03.2012 by LSCS in a rural city. According to mother’s statement the baby was born with distention of left side of lower abdomen. During antenatal check-up all pathological and ultrasonograpical findings were normal.

Then according to local physicians advice, the baby was admitted in a local hospital, during admission per abdominal examination was done and found soft distended abdomen, flank is full on the left side. Ultrasonogram shows large cystic mass in left renal region and extending upto epigastrium,? Congenital cystic kidney and right large retroperitoneal cystic mass. After that the baby was referred to Dhaka to consult with urologist. In Dhaka several investigations were done in different hospitals such as micturating cysto-urethrogram, USG and IVU. In IVU normal functioning right kidney with dilated ureter is seen at its upper third (? congenital) and non functioning or absent left kidney.

So with these investigations, there is no definite solution is made and still confusing. After that the patient was referred to United Hospital Limited for DMSA and DTPA scanning. DTPA and DMSA scanning shows right kidney is normal in size, shape and position with uniform radiotracer uptake with normal excretion of radiotracer but left kidney is not visualized in normal left renal fossa, it is ectopically present in antero-lateral aspect of left pelvic region with irregular bean shaped having low uptake. In DMSA relative renal function of right kidney is 76.61% and left kidney is 23.39% and DTPA renogram shows split renal function of right kidney is 84.64% and left kidney is 16.36% of the total renal function.

By these two renogram study pyeloplasty was done and after that the baby was gradually improving with increasing his weight and reduced abdominal distension and getting cure. As we all know Nuclear Medicine images at molecular level which ahead anatomical abnormalities. So whatever any suspected case of agenesis or absent kidney before going to any nephrotoxic study it is wise to have a Nuclear Medicine radionuclide study before any irreversible damage the safest, cheapest and efficient use to favor the location as well as functional status of renal tissue anywhere else in the abdomen.