Incidental crossed fused renal ectopia in a low-resource setting: Lessons from Ghana on diagnostic accuracy and imaging practice

Crossed fused renal ectopia (CFRE) is a rare congenital renal anomaly in which both kidneys are fused and located on the same side of the midline, often remaining clinically silent but carrying important implications because of aberrant vascular and ureteric anatomy. We report an incidental finding of CFRE in a 55-year-old Ghanaian woman who underwent routine abdominal ultrasound, which demonstrated bilaterally empty renal fossae and a lobulated reniform structure in the right iliac region. The mass showed preserved corticomedullary differentiation with a small cortical cyst, and subsequent contrast-enhanced computed tomography (CT) confirmed a right-sided lump-type CFRE with two distinct collecting systems, separate ureters crossing the midline to insert normally into the bladder, and anomalous renal arteries arising from the right common iliac and lower aortic branches. Multiphase abdominopelvic CT performed with optimized parameters (CTDIvol 17.12 mGy per series; estimated effective dose 33 mSv) provided comprehensive anatomic and vascular delineation, while laboratory evaluation revealed preserved renal function (eGFR 76 mL/min/1.73 m 2 ) with only trace leukocyturia. This case illustrates that CFRE may remain asymptomatic into late adulthood and emphasizes the complementary role of ultrasound and CT in diagnosis, particularly in resource-limited settings. Awareness of the condition and its associated vascular variants is essential for accurate interpretation, radiation-justified imaging, and safe surgical or interventional planning.