When a Horseshoe Is Not a Lucky Find

Area of Science:

• Pediatric Radiology
• Neonatal Imaging
• Point-of-Care Ultrasound

Background:

• Neonatal horseshoe kidney is an uncommon congenital anomaly.
• Early identification is crucial for long-term patient management.
• Emergency department evaluations require efficient diagnostic tools.

Purpose of the Study:

• To report a case of neonatal horseshoe kidney diagnosed via point-of-care ultrasound (POCUS).
• To highlight the utility of POCUS in identifying renal anomalies in neonates.
• To suggest modifications in renal POCUS technique for improved anomaly detection.

Main Methods:

• A neonate presenting with bloody diapers underwent renal point-of-care ultrasound (POCUS).
• Ultrasound examination focused on visualizing renal anatomy, including the isthmus.
• Standard renal ultrasound protocols were adapted based on initial findings.

Main Results:

• Point-of-care ultrasound clearly identified a horseshoe kidney in the neonate.
• The characteristic isthmus of the horseshoe kidney was visualized in the midline abdomen.
• The case demonstrated the feasibility of detecting this anomaly with POCUS.

Conclusions:

• Renal POCUS can effectively identify neonatal horseshoe kidney.
• Consideration of midline interrogation during renal POCUS is important when lower poles are difficult to visualize.
• Familiarity with anatomical variations is key for accurate POCUS interpretation in neonates.