Thoracic Ectopic Kidney with Diaphragmatic Hernia

Introduction

Ectopic kidney refers to an anomalous location of one of the kidneys. Ectopic kidney appears without any particular relation to age or gender; however, there is a tendency for it to be more frequently present on the left side, affecting the left kidney. This trend is partially explained by the fact that the right diaphragm is protected by the liver against any kind of inner pressure (Gupta 48).

The ectopic kidney can be pelvic (the most common type of the anomaly, which appears once in 3,000 autopsies), ileac, abdominal, or thoracic. The ectopic thoracic kidney is the rarest case with only 5% of all ectopias (which means that there is only one case in every 15,000 autopsies) and only 140 cases described in the world medical literature (4 of which are bilateral). In most cases, the diagnosis was made accidentally with the patients being unaware of the condition up to their mature age (Gupta 48). The paper at hand is going to provide a literature review of four articles on the topic to summarize features characterizing the condition, its causes, and treatment options.

Literature Review: Discussion

According to Murphy et al., exploration of this rare condition is complicated by the fact that all the relevant materials on the topic are case reports that provide no follow-up information, which makes it impossible to form a holistic picture (The authors claim that there were only 13 cases of the intrathoracic kidney reported over 25 years in the pediatric age group.) (970). To obtain the missing data, the researchers collected 5 cases of intrathoracic kidney in children and managed them non-operatively since 1992 (Murphy et al. 970). The results of the study proved that these kidneys functioned normally in spite of the anomaly. Moreover, none of the children had bowel herniation. However, two of them suffered from acute respiratory distress and had to be subjected to diaphragmatic hernia repair, whereas the other three were diagnosed accidentally. The authors conclude that no aggressive surgical approach is required for treating the condition as standard repair and nephropexy are quite effective, which makes non-operative management possible (Murphy et al. 973).

Adam et al. explore a rare case of the acquired form of the condition in a child with nephrotic syndrome, who previously had a congenital diaphragmatic hernia (922). The authors of the study are mostly concerned with the options of treating this rare form of ectopia. They suggest the use of MRI-urography as the most reliable tool for defining anomalous autonomy in small children (even during pregnancy). MRI is especially useful for the pediatric population as it does not emit ionizing radiation. The researchers also conclude that a renogram study can be helpful in identifying the position of the kidney that seems to be absent (Adam et al. 924).

Rouanne et al. agree with other researchers that the anomaly is typically asymptomatic and therefore discovered predominantly in adults (57). The authors investigate the rare case of a 1-year-old child to find out the embryonic background that predetermines the appearance of the pathology. However, they conclude that the causes remain unclear and that the anomaly can appear with equal chances as a result of a delay in the closure of the diaphragm or because of an ascent of the kidney before the closure (Rouanne et al. 59).

Shah et al. dwell upon Bochdalek hernia—a congenital diaphragmatic defect that is often associated with intrathoracic kidney (373). The researchers state that it is often the case that the kidney is confused with a thoracic mass, which brings about a series of redundant examinations and surgical interventions. They believe that the major task is to avoid such mistakes. This means that proper diagnosis makes it much easier to address the condition (Shah et al. 375).

Works Cited

Adam, Ahmed, Mariza De Villiers, and Gertruida Van Biljon. “Quest for the Missing Kidney in the “Treasure Chest”: Report of a Thoracic Kidney in a Child with Recurrent Diaphragmatic Hernia.” Urology, vol. 82, no. 4, 2013, pp. 922-924.

Gupta, Amit, et al. “Ectopic Intrathoracic Kidney: A Case Report and Literature Review.” Hong Kong Journal of Nephrology, vol. 15, no. 1, 2013, pp. 48-50.

Murphy, James J., Gabriel Altit, and Siham Zerhouni. “The Intrathoracic Kidney: Should we Fix it?.” Journal of Pediatric Surgery, vol. 47, no. 5, 2012, pp. 970-973.

Rouanne, M., et al. “A Rare Case of Ectopic Intrathoracic Kidney in a 1-Year-Old Child.” Urology, vol. 76, no. 1, 2010, pp. 57-59.

Shah, Arti D., et al. “Bochdalek Hernia with Intrathoracic Kidney.” Lung India: Official Organ of Indian Chest Society, vol. 29, no. 4, 2012, 373-375.