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Tian T, Chen H, Tang J, Luo H. Prenatal diagnosis of intrathoracic kidney and adrenal gland in left-sided congenital diaphragmatic hernia. Arch Gynecol Obstet 2024:10.1007/s00404-024-07449-7. [PMID: 38459998 DOI: 10.1007/s00404-024-07449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/25/2024] [Indexed: 03/11/2024]
Abstract
A 29-year-old primigravida at 31 weeks of gestation was referred for intrathoracic kidney (ITK). Ultrasound revealed left kidney intrathoracic placement with an anteriorly positioned ectopic adrenal gland. Magnetic resonance imaging confirmed diaphragmatic interruption and colon herniation. A female neonate, delivered at 37 weeks, underwent successful thoracoscopic repair for a left Bochdalek hernia. Despite compression of the left lung, notably optimistic lung-to-head ratio (LHR) values were observed, correlating with favorable outcomes. This case underscores the rare occurrence of ITK, its association with Bochdalek hernia, and the importance of comprehensive prenatal evaluations.
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Affiliation(s)
- Tian Tian
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Huizhu Chen
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Jing Tang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Luo
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
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2
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Theodorou DJ, Theodorou SJ, Bourantas LK, Tzimas T. Thoracic kidney: a mass in the chest. J Nephrol 2023; 36:303-304. [PMID: 36441498 PMCID: PMC9702605 DOI: 10.1007/s40620-022-01514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Daphne J Theodorou
- Department of Radiology, General Hospital of Ioannina, 13 Papadopoulos Street, Ioannina, Greece.
| | - Stavroula J Theodorou
- Department of Radiology, General Hospital of Ioannina, 13 Papadopoulos Street, Ioannina, Greece
| | - Lampros K Bourantas
- Department of Internal Medicine, Nephrology Unit, General Hospital of Ioannina, Ioannina, Greece
| | - Thomas Tzimas
- Department of Internal Medicine, Nephrology Unit, General Hospital of Ioannina, Ioannina, Greece
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3
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Živković V, Cvetković D, Atanasijević T, Nikolić S. Ectopic right thoracic kidney associated with Bochdalek hernia as the cause of diagnostic confusion. Forensic Sci Med Pathol 2021; 17:456-460. [PMID: 34061317 DOI: 10.1007/s12024-021-00385-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
A 61-year-old man who was a psychiatric patient and an alcoholic was admitted to hospital after a fall in his bathroom. He showed signs of hemorrhagic shock, and CT scans showed the presence of the right kidney and part of the right retroperitoneum in the right hemithorax, surrounded by liquid. Surgery showed that the right hemidiaphragm was intact and that no intraabdominal viscera prolapsed into thoracic cavity. The bleeding in the right retroperitoneum was evacuated. The surgical report also stated that "the right kidney and ureter were explored and no injuries or active bleeding were found". The patient died the third day after admission. Autopsy revealed a livid swelling covered with parietal pleura in the right half of the thoracic cavity, behind the costophrenic sinus, about 20 × 15x12 cm in size, filled with about 1500 ml of blood, with ectopic right kidney in the right half of the thorax, slightly rotated posteriorly and downwards. The kidney was smaller (80 g in weight), compared to the normally positioned enlarged left kidney (300 g). The right hemidiaphragm was also intact with small Bochdalek's foramen behind the posterior edge, with communication between the right retropleural and retroperitoneal spaces, through which intact elongated right renal artery (15 cm), vein (14 cm) and ureter were passing. The cause of death was hemorrhagic shock due to retroperitoneal bleeding, with coagulation disorder as possible contributing factor. Intrathoracic kidneys may pose many diagnostic and management dilemmas for clinicians and pathologists. Association between a Bochdalek hernia and an intrathoracic renal ectopia is very rare and may be confusing for doctors in different clinical situations.
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Affiliation(s)
- Vladimir Živković
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - Danica Cvetković
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - Tatjana Atanasijević
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia.
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Naseri M, Ghalibafan SF, Alamdaran SA. Ectopic Intrathoracic Kidney Associated with Ipsilateral Ectopic Spleen and Diaphragmatic Hernia in a Pediatric Patient: A Case Report. Tanaffos 2021; 20:291-293. [PMID: 35382088 PMCID: PMC8978037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrathoracic kidney is the rarest form of an ectopic kidney that is usually accompanied by left congenital diaphragmatic hernia (CDH) (Bochdalek hernia), the association of which with other anomalies is rare. CASE PRESENTATION Herein, we describe a case with a diagnosis of an intrathoracic kidney associated with the ectopic spleen and diaphragmatic hernia diagnosed during imaging studies for urinary tract infections (UTIs). This study reports an 11-month-old male case with a history of CDH and several episodes of UTIs. A kidney ultrasound revealed that the left kidney and spleen were located in the thoracic cavity. Despite intrathoracic lying of the left kidney, there was no vesicoureteral reflux. Technetium-99m dimercaptosuccinic acid scan reported a highly positioned left kidney . CONCLUSION With the consideration of a pediatric literature review among patients with intrathoracic ectopic kidney, our case was special and notable since it was the first neonate who had an association of intrathoracic spleen and kidney in the same side with a delayed diagnosis. The main point of this case was that radiologists should consider thoracic kidney a differential diagnosis of unilateral renal agenesis when there is a history of diaphragmatic hernia.
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Affiliation(s)
- Mitra Naseri
- Department of Pediatric Nephrology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,,Correspondence to: Naseri M, Address: Department of Pediatric Nephrology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Email address:
| | | | - Seyed Ali Alamdaran
- Department of Pediatric Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Halle-Smith JM, Pande R, Griffiths EA. Urgent surgical repair of symptomatic Bochdalek hernia containing an intrathoracic kidney. Ann R Coll Surg Engl 2020; 103:e10-e12. [PMID: 32829650 DOI: 10.1308/rcsann.2020.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | - R Pande
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - E A Griffiths
- University Hospitals Birmingham NHS Foundation Trust, UK
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Dell'Atti L, Galosi AB. Right ectopic intrathoracic kidney: Unusual clinical presentation in a young patient affected by scrotal varicocele. ACTA ACUST UNITED AC 2017; 89:323-324. [PMID: 29473389 DOI: 10.4081/aiua.2017.4.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022]
Abstract
Intrathoracic kidney is a partial or complete displacement of the kidney above the hemidiaphragm into the mediastinal compartment of the thorax. It is usually seen as an incidental finding discovered on chest radiograph or abdominal ultrasound. However computed tomography consents the correct detection of intrathoracic masses and defines their shape, size, and extent. We here report a case of ectopic thoracic kidney in a 22-year-old man who had a long history of scrotal discomfort associated with right varicocele. Frequently, this ectopia does not affect renal function and the stretched ureter provides good drainage. In literature, a small number of cases shows that varicocele is a possible mode of presentation of kidney tumors, but this is the first case of varicocele secondary to intrathoracic kidney ectopia.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona.
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Chen B, Finnerty BM, Schamberg NJ, Watkins AC, DelPizzo J, Zarnegar R. Transabdominal robotic repair of a congenital right diaphragmatic hernia containing an intrathoracic kidney: a case report. J Robot Surg 2015; 9:357-60. [PMID: 26530841 DOI: 10.1007/s11701-015-0530-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/01/2015] [Indexed: 12/21/2022]
Abstract
Bochdalek diaphragmatic hernia is a rare condition and is typically diagnosed prior to adulthood. Furthermore, right-sided defects are also uncommon due to the location of the liver, but can contain colon, omentum, small bowel, or rarely the kidney. Minimally invasive laparoscopic and thoracoscopic diaphragmatic hernia repairs are associated with improved outcomes when compared to open approaches-recently, robotic-assisted repairs have been performed in children with no morbidity and minimal complications. We report a case of an 80-year-old female who presented with an enlarging right-sided Bochdalek hernia containing an acquired intrathoracic kidney that was repaired using a robotic-assisted laparoscopic transabdominal approach with mesh placement. In this case, the robotic platform's advantages included excellent visualization of the posterolateral defect and efficient suturing during mesh placement. This approach is a viable option for skilled minimally invasive surgeons; however, further studies are warranted to investigate its utility in the management of diaphragmatic hernia repair.
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Affiliation(s)
- Brendan Chen
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, 525 E. 68th Street, New York, NY, 10065, USA
| | - Brendan M Finnerty
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, 525 E. 68th Street, New York, NY, 10065, USA.
| | - Neal J Schamberg
- Center for Gastrointestinal Medicine of Fairfield and Westchester, 500 West Putnam Avenue Suite 100, Greenwich, CT, 06830, USA
| | - Anthony C Watkins
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, 525 E. 68th Street, New York, NY, 10065, USA
| | - Joseph DelPizzo
- Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical College, 525 E. 68th Street, New York, NY, 10065, USA
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, 525 E. 68th Street, New York, NY, 10065, USA.
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Langer FW, dos Santos D, Dartora EG, Alves GRT, Haygert CJP. Ectopic Intrathoracic Kidney Presenting as Recurrent Pneumonias in a 1-year-old Infant: A Case Report. Lung 2015; 193:839-42. [PMID: 26153383 DOI: 10.1007/s00408-015-9760-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
Abstract
Ectopic intrathoracic kidney is a rare congenital anomaly, representing less than 5% of all renal ectopias. Most cases are discovered in asymptomatic adult patients undergoing imaging exams for unrelated reasons. Less than twenty cases of thoracic kidneys in the infant group have been reported in the literature, mostly comprising asymptomatic patients. Herein, we report a case of an 18-month-old boy with recurrent pneumonia episodes who was found to have a right-sided intrathoracic ectopic kidney. A brief literature review addressing the pathogenesis, prognosis, and treatment of this condition is also presented.
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Affiliation(s)
- Felipe W Langer
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, 97105-900, Brazil.
| | - Daiane dos Santos
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, 97105-900, Brazil.
| | - Eduardo G Dartora
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, 97105-900, Brazil.
| | - Giordano R T Alves
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, 97105-900, Brazil.
| | - Carlos J P Haygert
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, 97105-900, Brazil.
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9
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Affiliation(s)
- L Satija
- Classified Specialist (Radiodiagnosis), Department of Radiodiagnosis & Imaging, Command Hospital (Southern Command), Pune - 411 040
| | - V Maurya
- Trainee (Radiodiagnosis), Department of Radiodiagnosis & Imaging, Command Hospital (Southern Command), Pune - 411 040
| | - Hariqbal Singh
- Senior Advisor (Radiodiagnosis), Command Hospital (Western Command), Chandimandir
| | - G Balarangaiah
- Ex-Consultant (Radiodiagnosis), Department of Radiodiagnosis & Imaging, Command Hospital (Southern Command), Pune - 411 040
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