Bochdalek hernia with intrathoracic kidney as one of its contents Incidentally identified by[99m] Tc-DTPA renogram

ABSTRACT

Congenital diaphragmatic hernia [CDH] is a rare anomaly with a reported incidence of 1 in 16,000 populations. It may be associated with herniation of stomach, intestinal loops, spleen, and kidney through a chest wall defect. We report a case of a 1 year old male child who presented with recurrent fever, occasional chills and rigor of 4 months duration. Left kidney was non visualised on ultrasound examination. Patient was referred for a [99m]Tc DTPA [Diethylenetriamine penta-acetic acid] renogram to look for the presence of an ectopic left kidney. An intrathoracic left kidney was identified that was normally functioning and PUJ [pelviureteric junction] non obstructed. A routine chest X-ray was performed to look for respiratory tract infection that showed bowel loops in left posterior thorax, raising a suspicion for CDH. The patient underwent thoracoscopic repair of CDH and the hernial contents were found to be left kidney, intestinal loops and spleen. Intrathoracic kidney is relatively rare and constitutes 5% of all ectopic kidneys and is invariably PUJ non obstructed