A 16-year-old girl, with no prior medical history, presented to the emergency department following a motor vehicle crash. Hematuria was noted on evaluation. Subsequent work up included a computed tomography scan of the abdomen and pelvis, which revealed a horseshoe kidney with transection at the isthmus (Figs. 1 and 2, arrow). She remained stable, was managed conservatively, and was successfully discharged without complication.