Right Diaphragmatic Eventration with an Intrathoracic Kidney: Case Report and Review of the Literature

Abstract

We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged 17 years. The present case, though quite infrequent, shows the presence of an ectopic thoracic kidney on the right side. The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. The right hemithorax presented invasion of the thin loops, right colon, and kidney. The treatment approach was laparoscopic followed by thoracotomy using a dual mesh. The intrathoracic kidney remained in place. The outcome was satisfactory. Diaphragmatic eventration associated with thoracic renal ectopia is a very rare entity, considering the age, sex, and right location of the condition. It represents a clinical and diagnostic challenge; clinicians, radiologists, and surgeons must be alert with a high degree of suspicion in order to correlate symptoms and imaging findings and understand the etiopathogenesis. In addition, they should plan an adequate and individualized surgical repair making use, as far as possible, of the minimally invasive procedures that are currently used.

Heart on the left, diaphragm on the right: A case of congenital diaphragmatic eventration

“…9 Possible complications of diaphragmatic plication include pneumonia, dyspnea, pulmonary edema, and pleural effusion. 6 These complications, however, were not observed in our case.…”

“…In infants, these symptoms can be extremely debilitating due to the underdeveloped thoracic cage and intercostal muscle weakness resulting in paradoxical respiration ultimately necessitating the use of mechanical ventilation. 6 …”

Eventration of right diaphragm with an intrathoracic ectopic kidney: A case report

“…Investigations such as CT scans can help confirm the diagnosis. CT scanning can be utilized to define the dome elevation and the intrathoracic organ precisely [ 3 ], such as an ectopic kidney as in our case. In our patient, the intrathoracic ectopic kidney did not require further medical nor surgical treatment as previously reported [ 8 ].…”

“…Congenital diaphragmatic eventration is caused by developmental abnormalities, characterized by diaphragmatic muscular aplasia, involving a protrusion of the intraabdominal viscera into the affected hemithorax and resulting in respiratory distress [ 1 ], with incidence of <0.05% [ 2 ]. Ectopic kidney is a rare disorder with the incidence of 0.02–0.2% in the general population, while intrathoracic ectopic kidney is the rarest form of ectopic kidneys with the incidence of <5% of all ectopias [ 3 ]. Most cases are asymptomatic and discovered unintentionally while undergoing chest radiography [ 4 ].…”

“…Most cases are asymptomatic and discovered unintentionally while undergoing chest radiography [ 4 ]. Diaphragmatic eventration with an ectopic intrathoracic kidney is a very rare disorder with the incidence of 0.25% of all ectopias, requiring a personalized surgical repair to achieve a good outcome [ 3 ]. Moreover, it presents both clinical and diagnostic challenges due to variations in defect location, sex, and age at diagnosis [ 3 ].…”