Sagittal malrotated kidney with a large renal cyst: a case report of a rare type of kidney malrotation.

Introduction and importance: Renal malrotation is an uncommon congenital anatomical variation presents with various clinical manifestations; renal malrotations types include: incomplete rotation, reverse rotation, hyperrotation, and nonrotation. Renal malrotation along the sagittal plane, with the kidney's long axis positioned horizontally, represents an exceptionally rare phenomenon, with only three documented cases worldwide. Case presentation: A 45-year-old man with left-sided loin pain arrived at the urology clinic. Non-contrast computed tomography (CT) findings: few calculi in the lower calyx, a massive mid-zonal renal cyst that measured around 8 × 8 × 9 cm, and a sagittally malrotated kidney along its horizontal axis, which was a sign of an acquired ailment rather than a congenital defect. Clinical Discussion: Most cases of renal malrotation are identified incidentally during imaging studies, such as CT scans, which are often performed for unrelated reasons, including low back pain, urinary tract infections, or hematuria. Malrotation is often associated with other renal abnormalities, such as ectopia, horseshoe kidney, or other renal anomalies. Conclusion: Malrotated kidneys are uncommon and frequently discovered by accident, particularly those with a horizontal axis in the retroperitoneal space.