Right-Sided Intrathoracic Ectopic Kidney Associated with Symptomatic Bochdalek Hernia

In this case report, we describe an exceptional case of an adult Indian woman with a symptomatic right-sided ectopic intrathoracic kidney with a Bochdalek hernia. Bochdalek hernia is an inherited defect in the diaphragm that allows the abdominal organs to herniate into the thoracic cavity. It is the most common type of congenital diaphragmatic hernia (CDH) and is seen more frequently on the left hemithorax. An unusual condition known as ectopic kidney affects about one in every 1000 live births. The ectopic intra-thoracic kidney represents less than 5% of cases of renal ectopias, making it an uncommon occurrence. Adult cases of intrathoracic kidney associated with Bochdalek hernia are rare and usually the result of an accidental discovery. A 52-year-old obese female patient presented to the pulmonology outpatient unit and reported experiencing the symptoms of coughing, wheezing, and difficulty in breathing for 3 years. A chest radiograph revealed an elevated dome of the diaphragm on the right side. A Computed Tomography (CT) of the chest revealed a defect in the posterior aspect of the right hemidiaphragm with herniation of the right kidney and retroperitoneal fat into the right hemithorax. CT Urography showed normal size and enhancement of the intra-thoracic kidney with prompt excretion of contrast into the pelvicalyceal system. The patient was given the recommendation to undergo conservative treatment due to the fact that the hernia was small and there were no complications found on the CT Urography. The patient was followed-up every year. There was no occurrence of renal complications during the follow-up period. When evaluating patients with 'elevated hemi diaphragm' or thoracic 'mass', it is essential to check for the presence of an intra-thoracic kidney to avoid undesirable surgical procedures and image-guided biopsies. In most cases of ectopic thoracic kidney, its structure and function are normal; despite this, it should be considered in the evaluation of patients with ‘elevated hemi diaphragm’ or thoracic 'mass’ to prevent unnecessary surgical interventions and image-guided biopsies.