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Kummari S, Ramadugu R, Ramadugu S, Hussain Ansari M, Ali Ibrahim S. Right-Sided Ectopic Intrathoracic Kidney Associated With Symptomatic Bochdalek Hernia in an Adult Indian Female: Case Report and Review of Literature. Cureus 2024; 16:e60598. [PMID: 38894760 PMCID: PMC11184630 DOI: 10.7759/cureus.60598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Bochdalek hernia is an inherited posterior lateral defect in the diaphragm that allows the abdominal organs to herniate into the thoracic cavity. In addition to being the most prevalent variety of congenital diaphragmatic hernia (CDH), it is also the type that is observed on the left hemithorax the majority of the time. Ectopic kidney is an uncommon condition, and the occurrence of ectopic intrathoracic kidney is even more uncommon, accounting for only a few of all the cases of renal ectopias. The occurrence of intrathoracic kidney associated with Bochdalek hernia is infrequent among adult individuals and is typically an incidental finding. 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 since three 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 hemi-diaphragm with herniation of the right kidney and retroperitoneal fat into the right hemi-thorax. CT urography showed normal size and enhancement of the intrathoracic kidney with prompt excretion of contrast into the pelvicalyceal system. With regard to the small size of the hernia and considering the absence of complications on CT urography, a conservative treatment was proposed to the patient. 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 intrathoracic kidney to avoid undesirable surgical procedures and image-guided biopsies.
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Affiliation(s)
| | - Rithika Ramadugu
- General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, IND
| | - Sameera Ramadugu
- General Practice, Gandhi Medical College and Hospital, Hyderabad, IND
| | | | - Saad Ali Ibrahim
- General Practice, Shadan Institute of Medical Sciences, Hyderabad, IND
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Ortega-Mafla MF, Viveros-Gonzalez V, Saldarriaga-Gil W. Thoracic kidney and diaphragmatic hernia: prenatal diagnosis and successful management. Case report and review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2023; 74:237-243. [PMID: 37937910 PMCID: PMC10652776 DOI: 10.18597/rcog.4020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 11/09/2023]
Abstract
Objectives To report a case of prenatal diagnosis of ectopic intrathoracic kidney with diaphragmatic hernia managed surgically after birth, and to conduct a review of the literature on prenatal diagnosis of ectopic intrathoracic kidney and perinatal prognosis. Material and methods We report the case of a 28-week fetus in which, on ultrasound imaging, a mass was observed displacing the heart and lung in the right hemithorax, which was was confirmed by magnetic resonance (MR) to be an ectopic intrathoracic kidney (ITEK). After birth, the neonate was approached by laparoscopy to place a mesh in continuity with the diaphragm, leaving the kidney in the abdomen, with good evolution. A search was conducted in the PubMed, Embase and Cochrane databases for cohorts, case reports and case series of prenatal diagnosis of intrathoracic kidney in the fetus. Information was retrieved regarding design, population, imaging diagnosis, treatment and prognosis. Results The search identified 8 studies that met the inclusion criteria, reporting a total of 8 cases. Ultrasound diagnosis showed ectopic intrathoracic kidney associated with diaphragmatic hernia in all the subjects. Fetal magnetic resonance imaging (MRI) was also used in 5 cases. Conclusions Ectopic intrathoracic kidney is a congenital abnormality amenable to prenatal diagnosis. Survival after corrective surgery performed in the neonatal period is common. There is a paucity of publications, limited to case reports, regarding the prenatal diagnosis of this condition.
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Orlandi G, Toscano P, Gabrielli O, Di Lella E, Lettieri A, Manzo L, Mazzarelli LL, Sica C, Di Meglio L, Di Meglio L, Gulino FA, Incognito GG, Tuscano A, Cianci S, Di Meglio A. Prenatal Diagnosis of an Intrathoracic Left Kidney Associated with Congenital Diaphragmatic Hernia: Case Report and Systematic Review. J Clin Med 2023; 12:3608. [PMID: 37297803 PMCID: PMC10253368 DOI: 10.3390/jcm12113608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association. CASE PRESENTATION A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful. CONCLUSIONS CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
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Affiliation(s)
- Giuliana Orlandi
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (P.T.); (E.D.L.); (L.M.); (L.L.M.)
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Paolo Toscano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (P.T.); (E.D.L.); (L.M.); (L.L.M.)
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Olimpia Gabrielli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (P.T.); (E.D.L.); (L.M.); (L.L.M.)
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Enrica Di Lella
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (P.T.); (E.D.L.); (L.M.); (L.L.M.)
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Antonia Lettieri
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Luigi Manzo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (P.T.); (E.D.L.); (L.M.); (L.L.M.)
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Laura Letizia Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (P.T.); (E.D.L.); (L.M.); (L.L.M.)
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Carmine Sica
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
| | - Letizia Di Meglio
- Radiology Department, School of Medicine, University of Milan, 20133 Milan, Italy;
| | - Lavinia Di Meglio
- Pediatric Department, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy;
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy (A.T.)
| | - Attilio Tuscano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy (A.T.)
| | - Stefano Cianci
- Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Messina, Italy;
| | - Aniello Di Meglio
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy; (A.L.); (C.S.); (A.D.M.)
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Singh C, Shahnaz G, Handa R, Gupta NP, Sundar J. A missing kidney and a hidden congenital diaphragmatic hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:401-404. [PMID: 32915995 DOI: 10.1002/jcu.22916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/17/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Congenital intrathoracic kidney (ITK) is a rare condition, which is usually discovered incidentally in asymptomatic children who do not need any intervention. However, it may be associated with congenital diaphragmatic hernia (CDH), in which case it requires urgent surgical intervention. We present a case of prenatally diagnosed ITK associated with a left CDH that was operated on day 5 of life. The neonate is currently well at 15 months of age.
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Affiliation(s)
- Chanchal Singh
- Department of Fetal Medicine, Birthright, by Rainbow Children's Hospitals, New Delhi, India
| | - Gazala Shahnaz
- Department of Fetal Medicine, Birthright, by Rainbow Children's Hospitals, New Delhi, India
| | - Rakesh Handa
- Department of Paediatric Surgery, Rainbow Children's Hospitals, New Delhi, India
| | | | - Jayasree Sundar
- Department of Obstetrics and Gynaecology, Birthright, by Rainbow Children's Hospitals, New Delhi, India
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5
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Park J. Right intrathoracic ectopic kidney and pulmonary sequestration associated with right sided congenital diaphragmatic hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Thompson E, Simmons LQ, Baker AL. A Rare Finding: Right-Sided Congenital Diaphragmatic Hernia With an Intrathoracic Kidney. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319834571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Emma Thompson
- University of Arkansas for Medical Sciences, Imaging and Radiation Sciences, Little Rock, AR, USA
| | - Layla Q. Simmons
- University of Arkansas for Medical Sciences, Imaging and Radiation Sciences, Little Rock, AR, USA
| | - Anthony L. Baker
- University of Arkansas for Medical Sciences, Imaging and Radiation Sciences, Little Rock, AR, USA
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7
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Peng XX, Cheng SA, Liang QL, Luo XB, Hong XC, Yuan GL, Zhang HJ. Bilateral thoracic kidneys combined with inferior vena cava located behind the anterior abdominal wall: A case report and review of literature. World J Clin Cases 2018; 6:666-670. [PMID: 30430122 PMCID: PMC6232566 DOI: 10.12998/wjcc.v6.i13.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/16/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Ectopic thoracic kidneys are the rarest form of renal ectopia. Moreover, congenital abnormality of a primary anterior inferior vena cava (IVC) located behind the anterior abdominal wall is extremely rare. To date, only one such case has been reported. Herein, we report a rare case of a 55-year-old Chinese male with bilateral thoracic kidneys combined with an anterior IVC, a malformed liver, and a large-round-folds navel. The classification, clinical characteristics, and management options of a thoracic kidney was also summarized by literature review. To our best knowledge, the simultaneous detection of such multiple complex abnormalities has not been reported.
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Affiliation(s)
- Xiao-Xia Peng
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Shao-Ang Cheng
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Qi-Lian Liang
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Xing-Bo Luo
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Xiao-Cui Hong
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Gao-Le Yuan
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Hui-Jie Zhang
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
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8
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Hirsch S M. [Ectopic Kidney. A diagnostic case]. REVISTA CHILENA DE PEDIATRIA 2016; 87:208-210. [PMID: 26541703 DOI: 10.1016/j.rchipe.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/12/2015] [Accepted: 09/17/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Michael Hirsch S
- Médico Radiólogo Radist Chile. Profesor Asistente Adjunto, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
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9
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Impaction of an intrathoracic kidney acted as a shield against herniation of the abdominal viscera in a case of right congenital diaphragmatic hernia. Obstet Gynecol Sci 2016; 59:58-61. [PMID: 26866038 PMCID: PMC4742478 DOI: 10.5468/ogs.2016.59.1.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 01/13/2023] Open
Abstract
We describe a case of an intrathoracic kidney combined with right congenital diaphragmatic hernia (CDH) that was diagnosed at 32 weeks of gestation. Although it has been well established that a right CDH shows a poorer outcome than a left CDH, our present case showed a good outcome because there was no herniation of other abdominal viscera, except for the right kidney. Our findings in this case indicate that impaction of the intrathoracic kidney may act as a 'shield' against further herniation of other abdominal viscera into the thoracic cavity.
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10
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Juricic M, Cambon Z, Baunin C, Abbo O, Puget C, Crouzet K, Galinier P, Bouali O. Prenatal diagnosis of right-sided diaphragmatic hernia and ipsilateral intrathoracic kidney in a female fetus: a rare observation. Surg Radiol Anat 2015; 38:419-23. [DOI: 10.1007/s00276-015-1575-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023]
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Cessans C, Pharamin J, Crouzet K, Kessler S, Puget C, Bouali O, Galinier P, Marcoux MO. [Prenatal diagnosis of a right thoracic congenital ectopic kidney with a diaphragmatic hernia: a combination with a good prognosis]. Arch Pediatr 2015; 22:1176-9. [PMID: 26385648 DOI: 10.1016/j.arcped.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/10/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
Abstract
Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination.
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Affiliation(s)
- C Cessans
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France.
| | - J Pharamin
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - K Crouzet
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - S Kessler
- Centre de dépistage des Carmes, 31000 Toulouse, France
| | - C Puget
- Centre de radiologie rive gauche, clinique Sarrus-Teinturiers, 31100 Toulouse, France
| | - O Bouali
- Service de chirurgie viscérale pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - P Galinier
- Service de chirurgie viscérale pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - M-O Marcoux
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France
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12
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Jhun BW, Lee KJ. A right thoracic kidney with a pulmonary vascular malformation in an adult. Respirol Case Rep 2014; 1:55-7. [PMID: 25473544 PMCID: PMC4184529 DOI: 10.1002/rcr2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Ectopic thoracic kidneys are rare anomalies, accounting for less than 5% of all renal ectopia. The anomaly is usually found incidentally on a chest radiograph, with no respiratory or systemic symptoms. It usually presents in the left posteroinferior thorax, associated with a congenital diaphragmatic defect or hernia and is more frequent in males than females. Associated anomalies of other organs are rare and inconsistent. We report a case of a 55-year-old female who was referred to our hospital for evaluation of a mass-like lesion in the right chest, identified incidentally on a chest radiograph. Contrast-enhanced chest computed tomography revealed a right ectopic thoracic kidney with a closed diaphragm and an accompanying pulmonary vascular malformation.
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Affiliation(s)
- Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital Seoul Seoul, Republic of Korea
| | - Kyung-Jong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea
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Hidaka N, Fujita Y, Satoh Y, Fukushima K, Wake N. Sonographic appearance of intrathoracic kidney in a fetus with left diaphragmatic hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:600-602. [PMID: 22030954 DOI: 10.1002/jcu.20887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
Although prenatal diagnosis of congenital diaphragmatic hernia is not a rare event, detection of intrathoracic kidney in association is extremely rare. We present the sonographic findings in such a case. The postnatal outcome after successful respiratory management and surgical repair was good.
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Affiliation(s)
- Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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14
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Aksoy Ozcan U, Altun E, Abbasoglu L. Space occupying lesions in the fetal chest evaluated by MRI. IRANIAN JOURNAL OF RADIOLOGY 2012; 9:122-9. [PMID: 23329977 PMCID: PMC3522375 DOI: 10.5812/iranjradiol.3934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 01/09/2012] [Accepted: 02/06/2012] [Indexed: 02/06/2023]
Abstract
Background The most common space occupying lesions of the fetal thorax are congenital diaphragmatic hernia (CDH), congenital cystic adenomatoid malformation (CCAM), and bronchopulmonary sequestration (BPS). Although applications of prenatal MRI have been vastly improved in the recent years, its use in the assessment of space occupying lesions of the fetal chest differs among centers. Objectives To evaluate MRI findings in the diagnosis and follow-up of space-occupying lesions in the fetal chest with the review of relevant literature. Patients and Methods The fetuses with space-occupying lesions of the chest were retrieved from our 1.5T fetal MRI database of 347 patients. MRI features including the shape, signal characteristics, feeding artery, margin, mass effect, affected organ parts and anatomic location were reviewed. The results were correlated with the pathology results, follow-up and surgical findings. Results Nineteen MR images of 17 fetuses (mean gestational age, 23.8 weeks) with spaceoccupying lesions (5 CCAMs including one involuted case), 2 BPSs, 2 hybrid lesions, 8 CDH) were evaluated. One case of CCAM completely involuted in utero, four newborns were operated, and the resulting 12 fetuses were terminated. The surgical and pathological findings were in accordance with MRI findings. Conclusion MRI can reliably differentiate CDH from CCAM and BPS in utero. Follow-up is of utmost importance as lesions may involute or progress in utero. Prenatal MRI findings help postnatal decision-making, surgical planning and parental counseling.
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Affiliation(s)
- Umit Aksoy Ozcan
- Department of Radiology, School of Medicine, Acibadem University, Istanbul, Turkey
- Corresponding author: Umit Aksoy Ozcan, Department of Radiology, School of Medicine, Acibadem University, Acibadem Kozyatagi, Hastanesi Inonu Ave., Okur St., Istanbul, Turkey. Tel.: +90-2165714426, Fax: +90-2165332352, E-mail:
| | - Ersan Altun
- Department of Radiology, School of Medicine, Acibadem University, Istanbul, Turkey
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Chong SL, Chao SM. An Unusual Cause of Mediastinal Mass — A Case Report and Literature Review of Intrathoracic Kidney. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Posterior mediastinal mass is not an uncommon condition seen in clinical practice. It often generates anxiety among healthcare providers, as the most common cause of a posterior mediastinal mass is a neurogenic tumour which potentially can be malignant and carries serious consequences. A very rare but generally benign cause of such a mass is an intrathoracic ectopic kidney. Due to its rarity, literature on the intrathoracic kidney, its management, prognosis and complications is sparse and confined to case reports. We report a rare case of a two-month old baby who had a chest x-ray done for a prolonged cough and was found to have a posterior mediastinal mass, which was later diagnosed to be an intrathoracic ectopic kidney. The approach to mediastinal mass and literature review of an intrathoracic ectopic kidney and its complications are also discussed.
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Affiliation(s)
- Siew Le Chong
- Nephrology Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Sing Ming Chao
- Nephrology Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
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16
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Abstract
BACKGROUND Intrathoracic kidney is a rare congenital anomaly, with only 13 cases reported in the pediatric age group over the past 25 years. The relevant literature is limited to individual case reports or small case series with no follow-up data. Both operative and nonoperative management has been advocated. We report our experience in the management of children with an intrathoracic kidney as well as the efficacy of nonoperative management in select patients. METHODS Five cases of intrathoracic kidney were collected prospectively since 1992 and carefully followed up long term. RESULTS Two children presented with acute respiratory distress and underwent right diaphragmatic hernia repair and nephropexy. Incidental diagnosis of a left intrathoracic kidney was made in 3 children. Long-term follow-up has demonstrated normal function and development of these kidneys in all 5 children with no late bowel herniation in the nonoperative group. CONCLUSION Intrathoracic kidney associated with bowel in the chest should undergo standard repair and nephropexy. An isolated intrathoracic kidney without evidence of bowel herniation can safely be observed. This is the largest pediatric series of intrathoracic kidney as well as the first to document the efficacy of nonoperative management with long-term follow-up.
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17
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Athanasiadis AP, Zafrakas M, Arnaoutoglou C, Karavida A, Papasozomenou P, Tarlatzis BC. Prenatal diagnosis of thoracic kidney in the 2nd trimester with delayed manifestation of associated diaphragmatic hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:221-224. [PMID: 21480288 DOI: 10.1002/jcu.20769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 09/23/2010] [Indexed: 05/30/2023]
Abstract
Ectopic kidney is a rare congenital malformation, caused by renal malpositioning during embryogenesis. We report a rare case of ectopic kidney located in the left hemithorax of a male fetus. The unique features in this case were early sonographic prenatal diagnosis of thoracic kidney at 22 weeks' gestation, which was confirmed by fetal MRI, and delayed sonographic manifestation of the associated congenital diaphragmatic hernia at 27 weeks.
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Affiliation(s)
- Apostolos P Athanasiadis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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Maduekwe E, Weinberg B, Samaan B, Sheferaw E, Suntharos P. Right thoracic ectopic kidney in a child with breathing difficulties--sonographic diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:108-110. [PMID: 20564312 DOI: 10.1002/jcu.20716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Congenital intrathoracic ectopic kidney is a rare congenital abnormality that is usually found as an incidental lesion on chest radiographs. We report the case of a 6-month-old male with a 1-day history of breathing difficulties whose chest radiograph revealed a soft tissue right basilar mass. Further investigation utilizing ultrasound revealed a thoracic kidney. This case demonstrates the importance of sonography as a diagnostic tool in identifying thoracic kidneys in the pediatric age group.
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Affiliation(s)
- Echezona Maduekwe
- Department of Pediatrics Bronx-Lebanon Hospital, 1650 Selwyn Avenue, Suite 6D Bronx, New York 10457-7626, USA
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A Rare Case of Ectopic Intrathoracic Kidney in a 1-Year-old Child. Urology 2010; 76:57-9. [DOI: 10.1016/j.urology.2010.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 02/26/2010] [Accepted: 03/01/2010] [Indexed: 11/22/2022]
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Hasan M, Saba E, Bhatti A, Kanwal B. Diagnosis of Unilateral Thoracic Kidney by Color Doppler Ultrasound. J Med Ultrasound 2010. [DOI: 10.1016/s0929-6441(10)60005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Panda B, Rosenberg V, Cornfeld D, Stiller R. Prenatal diagnosis of ectopic intrathoracic kidney in a fetus with a left diaphragmatic hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:47-49. [PMID: 18615674 DOI: 10.1002/jcu.20503] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Intrathoracic renal ectopia as a result of a congenital diaphragmatic hernia (CDH) is a rare congenital anomaly. We present a case in which the prenatal diagnosis of an ectopic intrathoracic kidney was made on routine anatomical survey at 28 weeks' gestation. Color doppler sonography imaging revealed the renal artery coursing into the infant's thorax and was consistent with CDH, but fetal MRI suggested an intact diaphragm. However, neonatal evaluation confirmed the diagnosis of intrathoracic kidney with posterior CDH, which was repaired without complication. In contrast to diaphragmatic hernia with liver or bowel herniation, infants with intrathoracic ectopic kidneys generally do well.
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Affiliation(s)
- Britta Panda
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, CT 06610, USA
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Jeanty C, Nien JK, Espinoza J, Kusanovic JP, Gonçalves LF, Qureshi F, Jacques S, Lee W, Romero R. Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:378-87. [PMID: 17366518 PMCID: PMC2391071 DOI: 10.1002/uog.3958] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia. METHODS We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies). RESULTS A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02). CONCLUSIONS The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- C Jeanty
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD, USA
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Obatake M, Nakata T, Nomura M, Nanashima A, Inamura Y, Tanaka K, Nagayasu T. Congenital intrathoracic kidney with right Bochdalek defect. Pediatr Surg Int 2006; 22:861-3. [PMID: 16953455 DOI: 10.1007/s00383-006-1772-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2006] [Indexed: 10/24/2022]
Abstract
Intrathoracic kidney is a rare congenital anomaly. Since most reported cases are asymptomatic, it is extremely rare for this ectopia to be diagnosed in the neonatal period. We report a male infant with right intrathoracic kidney associated with Bochdalek defect. Chest X-ray demonstrated a right posterior mediastinal mass and intestinal gas in the right lung field. Contrast-enhanced CT and intravenous urography led to a diagnosis of intrathoracic kidney. Due to the presence of Bochdalek defect, the intrathoracic kidney was reduced into the abdominal cavity at the time of diaphragmatic repair. The intrathoracic kidney with attached adrenal gland was located at the level of the carina and was covered with protruded retroperitoneum. The kidney was thought to have been pushed this high by the small intestine and left lobe of the liver, which had also herniated through the defect. Postoperative hemodynamics and renal function were normal.
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Affiliation(s)
- Masayuki Obatake
- Division of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8501, Japan.
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Current Awareness. Prenat Diagn 2001. [DOI: 10.1002/pd.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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