In this case report, we describe an exceptional case of an adult
Indian woman with a symptomatic right-sided ectopic intrathoracic kidney with a
Bochdalek hernia. Bochdalek hernia is an inherited defect in the diaphragm that
allows the abdominal organs to herniate into the thoracic cavity. It is the
most common type of congenital diaphragmatic hernia (CDH) and is seen more
frequently on the left hemithorax. An unusual condition known as ectopic kidney
affects about one in every 1000 live births. The ectopic intra-thoracic kidney
represents less than 5% of cases of renal ectopias, making it an uncommon
occurrence. Adult cases of intrathoracic kidney associated with Bochdalek
hernia are rare and usually the result of an accidental discovery. A
52-year-old obese female patient presented to the pulmonology outpatient unit
and reported experiencing the symptoms of coughing, wheezing, and difficulty in
breathing for 3 years. A chest radiograph revealed an elevated dome of the
diaphragm on the right side. A Computed Tomography (CT) of the chest revealed a
defect in the posterior aspect of the right hemidiaphragm with herniation of
the right kidney and retroperitoneal fat into the right hemithorax. CT
Urography showed normal size and enhancement of the intra-thoracic kidney with
prompt excretion of contrast into the pelvicalyceal system. The patient was
given the recommendation to undergo conservative treatment due to the fact that
the hernia was small and there were no complications found on the CT Urography.
The patient was followed-up every year. There was no occurrence of renal
complications during the follow-up period. When evaluating patients with
'elevated hemi diaphragm' or thoracic 'mass', it is essential to check for the
presence of an intra-thoracic kidney to avoid undesirable surgical procedures
and image-guided biopsies. In most cases of ectopic thoracic kidney, its
structure and function are normal; despite this, it should be considered in the
evaluation of patients with ‘elevated hemi diaphragm’ or thoracic 'mass’ to
prevent unnecessary surgical interventions and image-guided biopsies.
Author(s)
Details
Satyanarayana
Kummari
All India Institute of Medical Sciences, Nagpur, India.
Rithika
Ramadugu
Kamineni Academy of Medical Sciences and Research Centre, Hyderabad,
India.
Sameera
Ramadugu
Gandhi Medical College and Hospital, Hyderabad, India.
Mustafa
Hussain Ansari
Shadan Institute of Medical Sciences, Hyderabad, India.
Saad
Ali Ibrahim
Shadan Institute of Medical Sciences, Hyderabad, India.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v3/1802
