P Manasa, Shah Isha, Sundaran P Shiyam, Murugan G
Department of Radiology, Sree Balaji Medical College and Hospital, Chennai, IND.
Cureus. 2024 Jul 26;16(7):e65452. doi: 10.7759/cureus.65452. eCollection 2024 Jul.
A congenital defect in the diaphragm, known as a Bochdalek hernia (BH), is a condition that allows herniation of the abdominal viscera into the thorax. BH is the most common type of congenital diaphragmatic hernia (CDH) and is typically detected on the left side. An ectopic kidney is a rare condition. An intra-thoracic ectopic kidney is an extremely uncommon condition. In adult patients, the presence of BH with an intra-thoracic kidney is extremely uncommon and is often a finding discovered unintentionally. A 51-year-old male patient presented to the outpatient unit of the pulmonology department. He stated that he had been suffering symptoms such as coughing, wheezing, and breathing difficulties for one year. A chest X-ray showed a well-defined radio-opaque lesion in the lower left zone. A computed tomography (CT) scan of the chest demonstrated a defect in the posterolateral region of the left hemidiaphragm, as well as herniation of the left kidney and retroperitoneal fat in the left hemithorax. The intra-thoracic ectopic kidney was found to be normal in size and showed normal attenuation and enhancement, with the contrast being promptly excreted into the pelvicalyceal system during CT urography. Due to the hernia's small size and lack of abnormalities on CT urography, the patient was recommended a conservative treatment. A follow-up examination was performed on the patient annually. Throughout the follow-up period, there was not a single episode of kidney-related issues. To avoid unwanted image-guided biopsies and surgical procedures, it is imperative to look for intra-thoracic kidneys in patients presenting with a thoracic mass or an elevated hemi-diaphragm.
一种被称为博赫达勒克疝(BH)的膈肌先天性缺陷,是一种使腹腔脏器疝入胸腔的病症。BH是先天性膈疝(CDH)最常见的类型,通常在左侧被检测到。异位肾是一种罕见病症。胸腔内异位肾则是极其罕见的情况。在成年患者中,同时存在BH和胸腔内肾的情况极为罕见,且往往是无意中发现的。一名51岁男性患者前往呼吸内科门诊就诊。他表示自己出现咳嗽、喘息和呼吸困难等症状已有一年。胸部X线显示左下区域有一个边界清晰的不透射线病变。胸部计算机断层扫描(CT)显示左半膈肌后外侧区域有缺损,以及左肾和腹膜后脂肪疝入左半胸腔。胸腔内异位肾大小正常,CT平扫及增强扫描显示密度及强化正常,在CT尿路造影过程中造影剂迅速排入肾盂肾盏系统。由于疝的尺寸较小且CT尿路造影未发现异常,建议该患者进行保守治疗。每年对该患者进行随访检查。在整个随访期间,未出现任何与肾脏相关的问题。为避免不必要的影像引导下活检和外科手术,对于出现胸部肿块或半膈肌抬高的患者,务必检查是否存在胸腔内肾。