Double Rarity Right Bochdalek’s Hernia with Intrathoracic Kidney: A Case Report

Abstract

Introduction: Bochdalek diaphragmatic hernia, a rare condition typically diagnosed before adulthood, presents diagnostic and therapeutic challenges. An even rarer occurrence involves the association of an intrathoracic right kidney with Bochdalek hernia. This article explores the complexities of treating such cases, considering both operative and non-operative options. Aims: This study aims to present an exceptional case of a 75-year-old woman with a developing right-sided Bochdalek hernia and an acquired intrathoracic kidney. The chosen approach was conservative, and through observation, we highlight the diagnostic and therapeutic intricacies of this entity. Presentation of Case: The patient, aged 75, diabetic, and hypertensive, presented to the emergency department with influenza-like illness. Clinical examination revealed stability but with a right basithoracic mass syndrome. Imaging, including thoracic radiograph and CT scan, confirmed a Bochdalek hernia and an intrathoracic right kidney. Given the fortuitous discovery, correct renal function, age, and comorbidity, a watch-and-see strategy was employed. The patient remained complaint-free during a 6-month follow-up. Discussion: Bochdalek hernia, characterized by a posterolateral diaphragmatic defect, is relatively rare but often asymptomatic. Right-sided defects, affecting 10-20% of cases, pose diagnostic challenges due to their infrequency. Surgical intervention is recommended, with options ranging from minimally invasive to open surgery. The management of an intrathoracic ectopic kidney remains debated, with some advocating for mobilization into the abdomen, while others opt for reduction without direct manipulation. Conclusion: Bochdalek hernias, particularly those associated with intrathoracic right renal ectopia, present diagnostic and management challenges. A high index of suspicion is crucial for timely diagnosis and treatment, leading to low morbidity and mortality rates. Clinicians should consider this condition in the differential diagnosis of lower intrathoracic masses.