• congenital renal anomaly
• horseshoe kidney
• renal anomaly

A 65 year old man was referred to the urology clinic with a two month history of right loin pain. He had no previous urological history. Situs inversus had been diagnosed previously during a routine appendicectomy.

Clinical examination and blood pressure were normal. Laboratory evaluation including blood urea, serum creatinine, 24 hour urinary protein, and urine culture were normal. A plain abdominal radiograph showed no calculi. An ultrasound scan identified a suspicious mass lesion, which demonstrated increased vascularity in the lower pole of the left kidney. A subsequent computed tomogram failed to identify a mass lesion but did reveal a congenital abnormality (fig 1) in addition to the previously diagnosed situs inversus (fig 2). The patient was reassured and discharged with instructions for a regular blood and urine check by his family doctor.

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Figure 1

Computed tomogram showing congenital abnormality.

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Figure 2

Computed tomogram showing situs inversus.