Symptomatic Ectopic Intra-thoracic Right Kidney in an Adult with Traumatic Diaphragmatic Hernia and Prior Left Nephrectomy: A Case Report

 

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Symptomatic Ectopic Intra-thoracic Right Kidney in an Adult with Traumatic Diaphragmatic Hernia and Prior Left Nephrectomy: A Case Report

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Muner
Mohamed
Muner Mohamed muner.mohamed@gmail.com Ochsner Medical Center Nephrology New Orleans United States *
Anees Mubarak anees.eljehawi@gmail.com University of Benghazi Faculty of Medicine Benghazi Libya -
Saber Khalid saber.khalid2014@gmail.com University of Benghazi Faculty of Medicine Benghazi Libya -
Mahmoud Alshaykhi m.y.alshaykhi18045@gmail.com University of Benghazi Faculty of Medicine Benghazi Libya -
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Diaphragmatic rupture following blunt thoracoabdominal trauma is a rare and often diagnostically challenging injury, with an incidence of just 0.8 to 5.8% . Right-sided ruptures are even less common, accounting for approximately 5 to 19% of all cases . Diagnosis is frequently delayed and difficult due to the scarcity of the injuries themselves and the presence of more obvious, masking injuries from trauma.

The following case represents an even rarer combination of factors. It is a case of a symptomatic right-sided diaphragmatic rupture in an adult Libyan female who presented with herniation of her right kidney into the thorax following a road traffic accident (RTA). Notably, she had previously undergone a left nephrectomy due to the same trauma, which highlights the complexity and multiorgan nature of such injuries.

A 47-year-old female presented to the Benghazi Medical Center (BMC) with a nine-month history of intermittent pain in the right hypochondrium. She had been involved in a car accident years ago, resulting in left kidney injury, for which she underwent left nephrectomy

Computed tomography (CT) scan of the lower thorax and abdomen showing the presence of the right kidney in the right hemithorax (red arrow), and the absence of both kidneys in the retroperitoneum (yellow arrows).

A CT scan of the lower chest and abdomen revealed an intra-thoracic herniation of the right kidney with malrotation (hilum faces anteriorly) through a posteromedial defect of the right hemidiaphragm, consistent with Bochdalek diaphragmatic hernia. The right renal pedicle and vessels appeared to be arising from their normal anatomical level with no stenosis or occlusion, although the scan is not a CT angiography (CTA).

The scan shows clear lung bases, a normal position of the right adrenal gland, and an average-sized liver with homogeneous diffuse fatty infiltration, with smooth contour and no focal lesions. The portal vein appears to be patent and homogenously enhancing. The rest of the scan was unremarkable.

Despite the abnormal kidney position, the patient's renal function test & electrolytes remain within normal ranges. They were Urea (serum): 23.814 mg/dL, BUN: 11.128 mg/dL, Creatinine (serum): 0.874 mg/dL, Na+: 136.1 mmol/L, K+: 3.8 mmol/L, Cl-: 106.2 mmol/L. Her blood work was otherwise normal

Based on the clinical presentation and the imaging findings, the patient was diagnosed with a right-sided Bochdalek diaphragmatic hernia with an ectopic intra-thoracic right kidney. And with her history of left nephrectomy , we believe this the first reported case of single intrathoracic kidney 

Kewords