szmtag Thoracic Tumor of Unclear Nature (23.10.2020)
DÄ internationalArchive43/2020Thoracic Tumor of Unclear Nature

Clinical Snapshot

Thoracic Tumor of Unclear Nature

Dtsch Arztebl Int 2020; 117: 734. DOI: 10.3238/arztebl.2020.0734

Weber, S; Meixner, F; Vahdad, R V

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MRI (axial, TrueFISP) confirms the ectopic thoracic position of the left kidney (red arrow) after recurrence of a congenital diaphragmatic hernia. Normal lung tissue is seen on the right side of the body. Bochdalek hernia was first described in 1848 by Vincent Alexander Bochdalek. The hernia is found on the left in 80–90% of cases and occurs more frequently in patients with syndromes.
Figure
MRI (axial, TrueFISP) confirms the ectopic thoracic position of the left kidney (red arrow) after recurrence of a congenital diaphragmatic hernia. Normal lung tissue is seen on the right side of the body. Bochdalek hernia was first described in 1848 by Vincent Alexander Bochdalek. The hernia is found on the left in 80–90% of cases and occurs more frequently in patients with syndromes.

A 3-year-old boy was brought to us with dyspnea, pulmonary obstruction, and fever. He was known to have tuberous sclerosis, and had undergone patch closure of a left-sided congenital diaphragmatic hernia after birth. Furthermore, he had recurring pneumonia and right convex torsion scoliosis. Virological examination identified a bocavirus infection as cause of the obstructive components. A chest radiograph obtained for diagnosis of pneumonia in the presence of dyspnea surprisingly revealed a circumscribed mass in the left lower lung. The impression on sonography, confirmed by magnetic resonance imaging (Figure), was of recurrence of the diaphragmatic hernia with intrathoracic protrusion of the left kidney through the retroperitoneally situated Bochdalek triangle. The kidney, which was found to have a long vascular pedicle, was simply and successfully returned to its previous normal location via thoracoscopic herniorrhaphy. An ectopic kidney in the thorax in association with Bochdalek hernia is an extremely rare event, and occurrence of the typical symptoms should prompt immediate surgical correction.

Prof. Dr. med. Stefanie Weber, Sektion für Pädiatrische Pneumologie, Klinik für Pädiatrische Nephrologie,
Transplantationsnephrologie und Allgemeine Kinderheilkunde, Universitätsklinikum Marburg, stefanie.weber@med.uni-marburg.de

PD Dr. med. Reza Vahdad, Klinik für Kinderchirurgie, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Marburg

Franziska Meixner, Klinik für Diagnostische und Interventionelle Radiologie,
Universitätsklinikum Marburg

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Weber S, Vahdad R, Meixner F: Thoracic tumor of unclear nature. Dtsch Arztebl Int 2020; 117: 734. DOI: 10.3238/arztebl.2020.0734

MRI (axial, TrueFISP) confirms the ectopic thoracic position of the left kidney (red arrow) after recurrence of a congenital diaphragmatic hernia. Normal lung tissue is seen on the right side of the body. Bochdalek hernia was first described in 1848 by Vincent Alexander Bochdalek. The hernia is found on the left in 80–90% of cases and occurs more frequently in patients with syndromes.
Figure
MRI (axial, TrueFISP) confirms the ectopic thoracic position of the left kidney (red arrow) after recurrence of a congenital diaphragmatic hernia. Normal lung tissue is seen on the right side of the body. Bochdalek hernia was first described in 1848 by Vincent Alexander Bochdalek. The hernia is found on the left in 80–90% of cases and occurs more frequently in patients with syndromes.