Adult intra-thoracic kidney: a case report of bochdalek hernia

Abstract

Introduction. Bochdalek hernia is a congenital posterior lateral diaphragmatic defect that allows abdominal viscera to herniate into the thorax. Intrathoracic kidney is a very rare finding representing less than 5% of all renal ectopias with the least frequency of all renal ectopias. Case Presentation. We report a case of a 62-year-old man who had a left thoracic kidney associated with left Bochdalek hernia. Abdominal X-ray and chest X-ray revealed dilated loops of the colon above left hemidiaphragm. Abdominal ultrasound (US) showed the right kidney with many fluid and esophytic cysts; left kidney was unfeasible to study because of the impossibility to find it. Computed Tomography (CT) basal scan demonstrated a left-sided Bochdalek hernia with dilatated colon loops and the left kidney within the pleural space. Magnetic Resonance (MR) confirmed a defect in left hemidiaphragm with herniation of left kidney, omento, spleen and colon flexure, and intrarotation with posterior hilum on sagittal plane. Conclusion. The association of a Bochdalek hernia and an intrathoracic renal ectopia is very rare, that pose many diagnostic and management dilemmas for clinicians. Our patient has been visualized by CT and MR imaging. A high index of suspicion can result in early diagnosis and prompt intervention with reduced morbidity and mortality.

Figure 1

Abdominal X-ray showed a dilated loops of the colon above left hemidiaphragm.

Figure 2

Ultrasonography imaging: normal right kidney (a) and absence of left kidney in the renal space (b).

Figure 3

Basal CT (computed tomography) imaging. (a) Axial scan illustrates the left renal ectopia with renal junction expanded. (b) multiplanar reconstruction (MPR) on coronal plane confirm Bochdalech hernia.

Figure 4

Magnetic resonance imaging (MRI). (a) T2 sequence on coronal view. (b) T2 sequence on sagittal plane. (c) T2-weighted image on axial plane. (d) Particular of left kidney on T2 axial view with fat suppression.

Figure 5

Magnetic resonance imaging (MRI). (a and b) THRIVE sequences with bolus of contrast medium injection; (c) axial T1-weighted sequence; (d) T1 post-Gd DTPA.