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Bochdalek hernia is a congenital 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. A 20 year old female presented with complaints of dry cough since 15 days and intermittent fever of 4 days duration. As part of routine investig...
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Morgagni hernia is an uncommon form of congenital diaphragmatic hernia. They are mostly asymptomatic but may sometimes present with non-specific symptoms. The absence of typical clinical manifestation in cases of Morgagni hernia leads to delay in diagnosis and subsequent treatment. Delayed or Missed diagnosis can lead to considerable morbidity and...
Citations
... 3 They are rarely associated with intrathoracic kidney. 4,5 Case reports do exist in the literature of Bochdalek hernias with intrathoracic kidney, but surgical repair is extremely rare. Most have been treated conservatively as the patients did not have any adverse effects. ...
... Most have been treated conservatively as the patients did not have any adverse effects. 2,4 Repair was indicated in this case. The hernia was particularly large and caused dyspnoea, which limited the patient's ability to mobilise, caused a significant restrictive spirometry picture and severely impacted her quality of life. ...
Bochdalek hernias rarely contain an intrathoracic kidney, and there are few reports of their operative repair. A woman presented with progressive dyspnoea limiting her quality of life. Imaging showed a Bochdalek hernia containing omentum, large bowel and the left kidney. The woman was unexpectedly admitted to the intensive care unit with respiratory failure secondary to gallstone pancreatitis whilst awaiting elective repair of her hernia. Surgical repair of the hernia was performed via laparotomy with cholecystectomy to treat both problems. The woman recovered well and is independently mobile without any exertional dyspnoea.
... CXR findings often reflect a posterior mediastinal shadow, with a rounded mass behind the cardiac silhouette and elevation of the affected hemidiaphragm [19]. CT provides characterization and anatomical definition of the lesion and helps in differentiating renal ectopia from causes for a posterior mediastinal lesion on chest radiograph, including pulmonary sequestration and neurogenic masses. ...
Background:
An intrathoracic kidney is a very rare form of ectopic kidney. Though increasingly recognized in the literature, impact on renal function is less well described. We report the case of a 67-year-old South Asian gentleman who presented with intrathoracic kidney and chronic kidney disease. We carried out a systematic review of the available literature on intrathoracic kidney, in order to characterize the typical clinical features, and describe likely clinical course and possible renal and extra-renal complications associated with this form of ectopia.
Materials and methods:
A structured search using PubMed identified all relevant published case reports from 1988 to 2018, with search restricted to papers in English, and to adult cases only (> 18 years of age). 124 records were identified, and after screening for eligibility, 34 case reports were analyzed.
Results:
Median age was 53.5 years, with no gender predominance. 68% (27/34) of cases were symptomatic. 29% (10/34) had a significant complication associated with their intrathoracic kidney, with 3 cases with either documented chronic or end-stage kidney disease. 26% (9/34) required surgical intervention.
Conclusion:
Though previously regarded as a benign entity, results from our systematic review, bearing in mind susceptibility to publication bias, suggests an appreciable risk of symptoms, complications, and in the minority a risk to kidney function. We recommend close biochemical and imaging surveillance of affected patients, with low threshold for intervention in those with renovascular stenosis, reflux, or hydronephrosis.
... graphy or renal scintigraphy. 3 Such abnormality, if asymptomatic, may not require any treatment unless complicating any other viscera. Occasionally, it may be erroneously considered as an intrathoracic mass. ...
... Occasionally, it may be erroneously considered as an intrathoracic mass. 3 The posterolateral defect in the diaphragm through which abdominal organs herniate into the thorax is known as Bochdalek's hernia. The pleuroperitoneal canal closes earlier on the right side, and hence, it is more common on the left. ...
Intrathoracic kidney is a rare developmental anomaly representing <5% of all ectopic kidneys. Here, we present a case of a 60-year-old woman who presented with nonspecific abdominal pain for two years, on and off in nature. She was investigated and found to have intrathoracic kidney within Bochdalek hernia. The idea of presenting the case is to have familiarity with this rare condition and keep a high index of suspicion to diagnose the same.
... Intrathoracic ectopic kidney accounts for 5% of all renal ectopias; its association with CDH is rare and has been reported to have an incidence of only 0.25%. 10 Further highlighting the rarity of an intrathoracic kidney, research conducted by Masturzo et al 11 assessed 15,919 autopsies of children, and only 1 case of intrathoracic kidney was found, with only a total of 22 ectopic kidney cases discovered. Embryologically, the kidney originates in the pelvis and ascends to interface with the adrenals, at which time their upward migration is halted. ...
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.
... Nuclear medicine plays an important role in the identification of some of the contents of CDH like kidney and spleen which may present as an intrathoracic mass or can be used as part of evaluation for non visualization of kidney, spleen or stomach using organ specific tracers like DTPA, phytate or TcO4 (Technetium pertechnetate) [5,6]. Diagnosis can be made by prenatal ultrasonogram examination (USG) but its accuracy can be limited by poor acoustic contrast between fetal lung, herniated viscera and position of fetus. ...
With technological advancements and wider availability of multimodality imaging, incidental lesions are frequently identified in patients undergoing various imaging studies. We report here a case of multiloculated disseminated perineural or Tarlov cysts (TCs). The primary aim of our study was to (1) provide a comprehensive review of the clinical, imaging and histopathological features of TCs (2) to draw attention to the fact that multiple lumbo-sacral and dorsal TCs can produce nerve injuries and serious movement disturbances (3) to document the usefulness of the magnetic resonance imaging (MRI) and bone scan in noninvasive diagnosis and guiding management in such cases. These cysts are clearly identified by MR and computerized tomography imaging of the lumbosacral spine. However, there are no reports on the scintigraphic findings of TCs in literature. TCs are typically benign, asymptomatic lesions that can simply be monitored. Until date, no consensus exists about the best surgical strategy to be followed for their management.
... Nuclear medicine plays an important role in the identification of some of the contents of CDH like kidney and spleen which may present as an intrathoracic mass or can be used as part of evaluation for non visualization of kidney, spleen or stomach using organ specific tracers like DTPA, phytate or TcO4 (Technetium pertechnetate) [5,6]. Diagnosis can be made by prenatal ultrasonogram examination (USG) but its accuracy can be limited by poor acoustic contrast between fetal lung, herniated viscera and position of fetus. ...
Congenital diaphragmatic hernia (CDH) is a rare anomaly with a reported incidence of 1 in 16,000 populations. It may be associated with herniation of stomach, intestinal loops, spleen, and kidney through a chest wall defect. We report a case of a 1 year old male child who presented with recurrent fever, occasional chills and rigor of 4 months duration. Left kidney was non visualised on ultrasound examination. Patient was referred for a 99mTc DTPA (Diethylenetriamine penta-acetic acid) renogram to look for the presence of an ectopic left kidney. An intrathoracic left kidney was identified that was normally functioning and PUJ (pelviureteric junction) non obstructed. A routine chest X-ray was performed to look for respiratory
tract infection that showed bowel loops in left posterior thorax, raising a suspicion for CDH. The patient underwent thoracoscopic repair of CDH and the hernial contents were found to be left kidney, intestinal loops and spleen. Intrathoracic kidney is relatively rare and constitutes 5% of all ectopic kidneys and is invariably PUJ non obstructed.
Bochdalek hernia is a congenital abnormality with high morbidity and mortality characterized by passage of the abdominal organs into the thoracic cavity through a diaphragmatic defect. Intrathoracic location of abdominal organs such as kidneys is very rare, with a reported incidence of only 0.25% in the literature. Herein, we present two cases of Bochdalek hernia with a herniation of intra-abdominal organ such as kidney that was treated in our clinic and compare this rare case with those in the literature. In both cases, the functionally normal kidneys were left in situ during diaphragmatic repair. No complications were observed during the postoperative period, and 10- and 1-year follow-ups. In cases with Bochdalek hernia associated with an intrathoracic ectopic kidney, the functionally normal ectopic kidneys were left in situ during repair of the diaphragmatic defect without complications.
