Wilms' Tumour in a Child with Horse Shoe Kidney seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto- A Case Report

Abstract

Background- Occurrence of Wilms' tumour in patients with horseshoe kidney is an unusual presentation, with incidence being higher than in the general population. Hence, it can lead to diagnostic and management challenges.
Objective- To report a case of Wilms' tumour that occurred in a child with horse shoe kidney in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.
Case report- UA an 18 month old boy presented with a six weeks history of progressive painless abdominal swelling. Abdominal examination revealed a huge right sided abdominal mass extending from the hypochrondium to the iliac fossa. Ultrasound revealed a huge heterogenous mass occupying the right hemi-abdomen extending from the right hypochondrium to pelvis. It crossed the midline to the contralateral side with multiple cystic portions and calcifications. The right kidney was not demonstrated while the left kidney was normal. Computed tomography (CT) scan showed a huge heterogeneously enhancing isodense mass occupying most part of the right lumbar region extending to the pelvis and crossing the midline. The mass was continuous with normal renal parenchyma on the inferomedial aspect consistent with Wilms' tumour. The inferior poles of both kidneys were merged in the midline in keeping with horse shoe kidney. Chemotherapy was commenced however he deteriorated
and died after 2 courses.
Conclusion- Wilms' tumour can occasionally occur in a child with horse shoe kidney. Hence, patients with horseshoe kidney should therefore be closely monitored for the possibility of co-existing Wilms' tumour.

Key words- Horse shoe kidneys, Wilms' tumour, Child, diagnostic challenge.