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.
ABSTRACT
Background Anorectal fistulas are chronic inflammations of peri-anal tissues that form a connection between the perineal skin and the anal canal. Accurate preoperative evaluation of the main fistula's trajectory and pelvic tissues is essential for effective surgical treatment of anal fistulas. The inability to detect concealed lesions may result in the recurrence of fistulas and the conversion of a simple fistula into a complex fistula. Magnetic resonance imaging (MRI) imaging can detect concealed pathways and abscesses, thereby exposing the intricate connection between the fistula and anal-sphincter complex. This data serves as a roadmap for making surgical decisions, thereby reducing the likelihood of illness recurrence and complications after surgery. Aim To evaluate the role of MRI in pre-operative assessment of an anorectal fistula, compare its findings with surgical results. Materials and methods The research was conducted at the Radiology Department, Apollo Hospital, Hyderabad. It was a prospective observational study. IBM SPSS Statistics for Windows, Version 17 (released 2008; IBM Corp., Armonk, New York, United States) was utilized for data analysis. The mean and standard deviation were computed. We further applied appropriate statistical tests to determine the significance of MRI features with pre-operative findings. Results MRI accurately detects features like abscesses (sensitivity-100%, specificity-97.06%), secondary tracts of the fistula (sensitivity-93.55%, specificity-94.12%), horseshoe appearance, and supralevator extension (sensitivity-100%, specificity-97.50%, and 97.62%, respectively). Conclusion When comparing our results with intraoperative findings, MRI showed high sensitivity and specificity in detecting abscesses, secondary tracts, horseshoe appearances, and supralevator extensions. Our findings suggest that MRI can offer anatomical and pathological information for the pre-operative care and surgical planning of perianal fistulas.
