A duplex kidney with dromedary hump showing altered hilar anatomy

A comprehensive knowledge of the wide range of variations of renal vasculature and renal pelvis is mandatory to the anatomists for a better understanding of the embryology. It remains as the key issue in determining the technical feasibility of various endourologic procedures and innumerable intervention techniques besides kidney retrievals for transplantation. In the present case the duplex kidney showed lobulations on the anterior surface just adjacent to the hilar region. The midlateral portion of the convex lateral border of the kidney showed a small focal bulge –dromedary hump. At the hilum reversed anterio-posterior disposition of renal vasculature with anteriorly placed renal artery which bifurcated into two upper and lower anterior segmental branches. The renal vein formed by large tributaries arising from the hilum running towards the inferior vena cava. The renal pelvis was most posteriorly placed which showed a double pelvis. The upper pelvis was seen arising behind the renal vein and the lower pelvis arising inferomedial to the lower anterior segmental artery. Both the pelvises were seen uniting medial to the lower part of hilum and continued as a single ureter which opened into the bladder. The thorough knowledge of these anatomical variations is necessary to avoid iatrogenic injuries and enable the surgeon and radiologists approach unusual situations with confidence rather than surprise.