Presentation
Routine abdominal ultrasound examination (known autoimmune disease). During the examination, the patient mentioned occasional mild hematuria. Mostly slept on her left side.
Patient Data
In the supine position, the right kidney was in a slightly inferior position. In the erect position, the right kidney moved towards the midline.
When the patient was lying on her left side:
the right kidney moved across the midline (ventral to the aorta and IVC)
after a few minutes, mild pylon and calyx dilation appeared, suggesting ureter obstruction, likely due to kinking
ureter kinking was visible after a few minutes
no right kidney arterial or venous flow changes were visible
Patient starting position: lying on her left side. Patient end position: supine. Probe position: ventral transverse orientation. The probe position was maintained relative to the patient.
The right kidney was visible in front of the aorta, slightly on the left side of the retroperitoneal space. In the supine position, the right kidney moved back to its normal place (but still slightly into a lower position).
Case Discussion
Before the examination, no renal pain or symptoms were known. The routine ultrasound examination identified nephroptosis. Targeted questions revealed occasional mild hematuria and left-sided sleeping habits. The examination was extended to identify possible vascular or ureter kinking and stricture. Ureter kinking and pylon/calyx dilation were confirmed, which might have caused intermittent hematuria. No vascular complications were observed.
This case demonstrates the importance of:
communication with the patient during the ultrasound examination after incidental findings
evaluating the kidneys in different patient positions, even if no symptoms are known
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