Intrathoracic Kidney Research Articles

Laparoscopic management of delayed traumatic left diaphragmatic hernia with intrathoracic kidney: A rare case report and technical aspects

Abstract Occult traumatic diaphragmatic hernias (DHs) are relatively rare and may present years after the trauma. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal organs. Traumatic migration of the kidney into the thorax is a very uncommon event. We herein report a rare case of a 34-year-old male patient with a symptomatic DH secondary to a motor vehicle accident and a history of laparotomy for liver laceration 10 years back who underwent laparoscopic reduction and intraabdominal reposition of left kidney from thorax, suture repair of the defect with mesh reinforcement. Thoracoscopic visualization was performed to assess the efficiency and completeness of the repair and to rule out any iatrogenic pericardial injury after mesh fixation. The operative technique, difficulties encountered, and tips to overcome these challenges were discussed. With adequate expertise, reduction, and repositioning of migrated kidney, suture closure of the defect with mesh reinforcement is safe and feasible by laparoscopic approach.

Renal Ectopia in the Pelvic Area: A Rare Case

Renal ectopia is a positional defect during development, consistently accompanied by malrotation, always involving abnormal vascularization with one or more ectopic arteries and a ureter of appropriate length for the location of the kidney. It is distinct from renal ptosis. Several types of ectopias are distinguished: on one hand, simple ectopias occurring in the vertical direction (intrathoracic kidney, low-lying kidney) or in the transverse direction (crossed ectopia), and on the other hand, ectopias with symphyses. Pathological pelvic ectopic kidney is rare. It is often revealed by pain, infectious complications, urinary lithiasis, or sometimes fortuitous discovery. We report the case of a 60-year-old patient with a history of hip prostheses, incidentally discovering, through a diagnostic assessment for nephritic colic due to contralateral ureteral lithiasis, a left ectopic kidney in the pelvic area on a CT scan. Based on this case and literature data, we will discuss the etiopathogenic, clinical, radiological, and therapeutic aspects of this malformation.

Right thoracic kidney – A rare case report in a female patient

Ectopic kidneys are one the most common forms of renal anomalies. However, intrathoracic kidneys are extremely rare, especially on the right side. Reporting of such cases is relatively very less common in the literature, particularly in the case of females. The current case is an accidental finding noted in a 56-year-old female who came with complaints of diffuse abdominal pain. An initial ultrasound abdomen revealed an absence of the right kidney in the right renal fossa and computer tomography done later revealed a right intrathoracic kidney with a higher origin of the right renal artery (T12 vertebral level). The right ureter was longer and opened into the bladder normally. The author presents this case because of its anatomical, developmental, and clinical importance.

Ectopic Intrathoracic Kidney due to Diaphragmatic Eventration Detected on Bone Scan.

The technetium-99m methylene diphosphonate (99mTc-MDP) whole-body bone scan along with single-photon emission computed tomography (SPECT/CT) can detect challenging soft tissue uptake patterns. We present a case of a 67-year-old female in whom the 99mTc-MDP scan, performed 3hours after injection, revealed abnormal soft tissue uptake in the right thoracic region. No functioning right kidney was seen in the right lumbar region. Hybrid SPECT/CT revealed an ectopic right kidney in the subdiaphragmatic location, accompanied by gut loops and eventration of the right-sided diaphragm. This case underscores the value of SPECT/CT in identifying and characterizing unexpected anatomical abnormalities, such as ectopic kidneys.

Intrathoracic kidney: An unusual cause of shortness of breath.

Intrathoracic kidney: An unusual cause of shortness of breath.

Conservative approach in adult right-sided Bochdalek hernia with an intrathoracic ectopic kidney

Bochdalek hernia (BH) is a congenital diaphragmatic defect primarily diagnosed in neonates and is usually left-sided. Adult diagnosis, especially of right-sided BH is exceedingly rare and usually presents with symptoms. Till now, only 31 cases have been diagnosed to be right-sided BH along with intrathoracic kidney. This report presents a 26-year-old asymptomatic male who was incidentally diagnosed with a massive right congenital diaphragmatic hernia. Imaging revealed severe abdominal herniation, a right intrathoracic ectopic kidney, and a right liver lobe hypoplasty along with hypertrophied left liver lobe extending down to the pelvic cavity. Several surgeons were consulted, with controversial opinions on whether elective surgery should be performed or withheld. Due to the high risk associated with surgery and the patient’s choice, the surgery was deferred. For almost 18 months, the patient did not report any symptoms or complications. This case highlights the rarity of asymptomatic right-sided BH in adults and the challenges in determining a management approach. Also, it proposes a conservative approach for such patients as a management modality. Most extensive diagrammatic defect reported is estimated to have a neck defect of 10 cm. Most BH cases have been treated surgically and reports on the outcome of a conservative approach are exceedingly rare. In such cases, patient preferences and a thorough risk assessment play vital roles in decision-making regarding conservative versus surgical approaches.

Prenatal Diagnosis of an Intrathoracic Left Kidney Associated with Congenital Diaphragmatic Hernia: Case Report and Systematic Review.

A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association. A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful. CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.

Intrathoracic Kidney.

Intrathoracic kidney is an extremely rare condition that should be considered in the differential diagnosis of intrathoracic masses.There is a lack of literature on this type of kidney ectopia and its consequences in asymptomatic individuals.

Imaging of Intrathoracic Ectopic Kidney

The intrathoracic kidney is one of the rare causes of the congenital ectopic kidney. The present study discusses a case referred to our clinic with a pre-diagnosis of renal agenesis and a diagnosis of the intrathoracic ectopic kidney. The case is a 9-year-old patient who applied to our clinic complaining of abdominal pain. The left kidney could not be shown in the abdominal ultrasonography for the patient's abdominal pain. In the Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy performed on this, the left kidney was detected far above its normal localization. On the thorax plus upper abdominal, the patient's computed tomography showed that the left kidney was intrathoracically located and the diaphragmatic hernia. The left kidney may not be visualized on ultrasonography in the patient. Therefore, the ectopic kidneys should be visualized by Tc-99m DMSA scintigraphy. In selected cases, computed tomography should be used to determine the proper localization of the intrathoracic kidney and whether there is a diaphragmatic hernia.

Intrathoracic Kidney with Diaphragmatic Eventration: A Case Report

Intrathoracic Kidney with Diaphragmatic Eventration: A Case Report

An Ectopic Intrathoracic Kidney in an Adult Female: A Case Report

The kidney is an organ prone to congenital anomalies owing to its complex and sequential development. Ectopia of the kidney is a rare entity with intrathoracic ectopia being an exceptionally uncommon occurrence. Intrathoracic kidneys represent less than 5% of all renal ectopias with a prevalence rate of less than 0.01%. The concurrent association of an intrathoracic kidney with a Bochdalek hernia is extremely infrequent with an incidence of 0.25%. Most of the patients are asymptomatic and have an uneventful clinical course. It is often incidentally detected simulating a posterior mediastinal mass. Thoracic kidney is a condition that shows male predominance. Here, present case is of a 43-year-old female patient who presented to the institution with breathlessness and associated chest pain. Computed Tomography (CT) scan revealed left-sided Bochdalek hernia with the left kidney, adrenal gland, transverse colon, splenic flexure and proximal descending colon within the thorax. The patient underwent elective diagnostic laparoscopy followed by reduction of the contents and mesh repair of the diaphragmatic defect. The patient was discharged and remained asymptomatic on a periodic follow-up of over a year. Awareness regarding this rare entity can obviate the need for a battery of unnecessary investigations and operative procedures.

Incidental finding of a recurrent Bockdalek hernia with an intra-thoracic kidney

Bockdalek hernia is a rare type of congenital diaphragmatic hernia which was firstly described by Vincent Alexander Bockdalek in 1848.[1] The hernia sac is more commonly located on the left due to protection of the right side of the diaphragm by the liver, and contents can include spleen, small bowel, liver, colon or kidney.[1] Bockdalek hernia with intra-thoracic kidney is extremely rare and the reported incidence is less than 0.25%.[2] During embryogenesis the developing kidney which is located in the pelvis migrates upwards to fuse with the adrenal glands. Sometimes, this upward migration of the developing kidney does not stop at its designated point and thus the kidney reaches into the thorax. [3] Treatment options for Bockdalek hernia may include open or laparoscopic surgical repair, which involve the reduction of the herniated organs and closure of diaphragmatic defect with or without prosthetic mesh.[4] Herein we report a rare case of recurrent Bockdalek hernia including an intra-thoracic left kidney in a 59 year old lady with a past history of a Bockdalek hernia that was repaired at the age of 3, who presented to our hospital with severe lower abdominal pain and vomiting.

Intrathoracic Renal Ectopia: A Case Report and Review of the Literature

: Renal ectopy is a rare phenomenon, which its diagnosis may be delayed due to an asymptomatic condition. The ectopic kidney may even have a normal functional state; however, because of occurring kidney blockade, the risk for kidney stones and even failure may be raised. In many cases, the diagnosis is completely incidental and is based on the request of radiography and sometimes, CT scan even for other reasons. In the therapeutic approach, in cases of kidney blockage, or urine backing up to the kidney, the surgical intervention is highly recommended by excisional removing the mass. Herein, we described a case of ectopic intrathoracic kidney initially presented with mild respiratory distress that was ultimately diagnosed by CT scanning and removed surgically.

Intrathoracic kidney, dextroposition of the heart, right upper and middle lobe hypoplasia of lung and pulmonary hypertension

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Right-sided Bochdalek hernia associated with an intrathoracic kidney in an adult

A 37-year-old, morbidly obese (body mass index: 47.5) woman with Down syndrome, severe mental impairment, and institutionalization was referred to the outpatient surgery unit of our institution by her primary care physician owing to an asymptomatic ventral hernia. There was no history of abdominal trauma, and she reported no gastrointestinal or urinary symptoms. A physical examination revealed a painless giant ventral hernia with loss of domain.

A rare Case of Right Sided Bochdalek Hernia Co-existing with Intrathoracic Kidney

A rare Case of Right Sided Bochdalek Hernia Co-existing with Intrathoracic Kidney

Dyspnea Caused by Bochdalek Hernia Associated With Intrathoracic Kidney

Dyspnea Caused by Bochdalek Hernia Associated With Intrathoracic Kidney

A Rare Finding: Right-Sided Congenital Diaphragmatic Hernia With an Intrathoracic Kidney

Congenital diaphragmatic hernia (CDH) is an opening in the diaphragm in which the abdominal viscera protrudes into the chest as the result of an embryologic defect. CDH can be an isolated anomaly or occur simultaneously with a chromosomal abnormality or genetic syndrome. Prognosis for fetuses with CDH is widely variable and depends on numerous factors including premature birth, the presence of a chromosomal abnormality or genetic disorder, location of the herniation, lung volume, and cardiac involvement. This study presents details of a case of right-sided CDH with an intrathoracic kidney detected sonographically. Fetal echocardiography and magnetic resonance imaging (MRI) were used to further characterize the herniation. Both sonography and MRI aided in accurate diagnosis and postnatal treatment planning.

Prenatal diagnosis of ectopic intrathoracic kidney with right congenital diaphragmatic hernia manifesting as fetal mesocardia

Prenatal diagnosis of ectopic intrathoracic kidney with right congenital diaphragmatic hernia manifesting as fetal mesocardia

Rim ectópico intratorácico em paciente pediátrico

A Residência Pediátrica (RP) é uma revista eletrônica trimestral, em publicação contínua, da Sociedade Brasileira de Pediatria (SBP), disponível em português e inglês, destinada aos médicos residentes de nossa especialidade, áreas afins e aos pediatras. O conteúdo da revista pode ser acessado livremente. A missão da RP é contribuir para a formação acadêmica dos residentes e incentivá-los a uma participação ativa na produção científica sobre temas pediátricos e relacionados à adolescência.