1Department of Anatomy, Melaka Manipal clinical College (Manipal Campus), Manipal University, Madhav Nagar, Karnataka, Manipal 576104, India


Imaging technology with its advancement in the ar of urology is the boon because that the patient who need minimally invasive philosophies for various kidney disorders. These approaches require a an accurate knowledge that the normal and also variant anatomy the vascular structures at the hilum of the kidney in terms of their sample of arrangement and also division. The present record describes a bilateral anomalous arrangement of the frameworks at the renal hilum and their peculiar branching pattern which is the clinical and surgical relevance. Multiple branching that the renal vessels was observed in both kidneys because of which the hila were congested. The appropriate renal artery immediately after its origin divided into 2 branches. The upper branch stood for an aberrant artery vice versa, the lower branch gave 5 divisions. The left renal artery additionally divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch take it an arched course and also gave 6 branches. The posterior branch provided 3 terminal branches prior to entering the renal substance. In enhancement to anomalous hilar structures, normal design of both kidneys to be altered and also the hilum the the left kidney was discovered on the anterior surface.

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1. Introduction

Kidneys room a pair the excretory organs situated one on each side that the vertebral tower retroperitoneally. Being v a bean shape, it gift thick and also rounded exceptional pole and thin and also pointed inferior pole. Renal hilum is deep upright slit situated in the medial border i m sorry lies around 5 cm from the midline the opposite the reduced border that L1 vertebra. It communicates with the renal sinus in ~ the kidney <1>. Follow to conventional description in traditional anatomy textbooks, at the hilum, normally the renal vein is the anterior largely with the renal artery posterior come it and also the pelvis that kidney lying further posteriorly <2> Various instance reports have actually been released which report feasible variations in the setup of frameworks at the hilum. However bilateral anomalous sports of the renal vessels along with abnormal shape of the hilum have actually not yet been reported.

Knowing the anatomy that the ureteropelvic junction of the kidney is essential for knowledge urinary tract disorders and also various nephron sparing operation procedures. The existing study defines the bilateral anomalous setup of the structures at the hilum that kidney i beg your pardon is of clinical and surgical relevance.

2. Case Report

During dissection of about 60-year-old masculine cadaver, we observed anomalous positions and also branching sample of the renal vessels bring about a congested renal hilum. The variation was bilateral (Figure 1). The hilar an ar was dissected carefully and the structures and also their relations were clearly defined. The normal style of p shaped kidney was totally distorted bilaterally. Formation of renal pelvis was regular on both kidneys but the sport is together reported below.


Anomalous vascular branching pattern and also their food in the hila that bilateral kidney. IVC: worse vena cava, AA: ab aorta, RU: right ureter, RTV: appropriate testicular vessels, LTV: left testicular vessels, RRV: right renal vein, LRV: left renal vein, and also LSRV: left supra renal vein.

2.1. On the right Side

Renal artery (RA) with its normal origin and course from ab aorta divided instantly into 2 branches (Figure 2). The superior branch pierced the upper pole that the kidney there is no passing through the hilum. It stood for the aberrant artery (AA). It offered a thin branch i beg your pardon descended under to the hilum. The inferior branch coursed forward to the hilum and just prior to entering the problem of the kidney it provided six divisions. The top 4 branches got to the hilum happen anterior come the renal vein, whereas the reduced 2 branches pass posterior come it. The 2 tributaries of renal vein (RV) after emerging from the hilum joined to type a single trunk as best renal vein exterior the hilum and it drained right into the worse vena cava.


Right kidney: mirroring congested hilum as result of multiple branching pattern of renal artery (RA). AA: aberrant artery, RV: renal vein, IVC: inferior vena cava, and U: ureter.

2.2. ~ above the Left Side

The hilum was vast and positioned on the anterior surface instead of its normal anatomical instance in the medial border (Figure 3).


Left kidney: reflecting congested hilum and also distorted form of the kidney. RA: renal artery, RV: renal vein, IVC: inferior vena cava, U: ureter, and also LTV: left testicular vein.

Left renal artery developed from abdominal muscle aorta, before entering the hilum branched right into 2 divisions. Anterior department presented one arched course superficial come the tributaries of renal veins and also gave 6 branches. The top 2 branches of it represented the aberrant arteries and entered the upper pole of the kidney. Among the aberrant arteries before piercing the substance of the kidney offered the right inferior suprarenal artery. The posterior department ran behind the renal pelvis and posterior division of renal vein and gave 3 branches. So altogether, 8 branches pierced the renal hilum and 2 branches pierced the top pole that the kidney.

Anterior and posterior tributaries of renal vein after arising separately indigenous hilum that the left kidney unified to kind a single trunk the drained into inferior vena cava. Prior to the union, the posterior division joined the anterior department in a twisted manner. Anterior department received left testicular vein (LTV). The left suprarenal vein (LSRV) drained right into the trunk of the left renal vein. So the arrangement of the structures in the hilum of left kidney indigenous anterior to posterior element was anterior division of the renal vein-anterior department of renal artery-renal pelvis-posterior department of renal vein-posterior department of renal artery (A-V-P-V-A).

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The schematic representation of bilateral renal hilar pattern through distorted shapes of kidney is shown in number 4.