Asymptomatic renal thoracic ectopia, pulmonary hypoplasia, and Bochdalek hernia.

Right sided intrathoracic kidney associated with ipsilateral pulmonary hypoplasia and Bochdalek hernia in a 13 year old girl was diagnosed by computed tomography. Department of Respiratory Medicine G Hulks JW Kerr Department of Diagnostic Radiology, Western Infirmary, Glasgow MD Cowan Address for reprint requests: Dr G Hulks, Department of Respiratory Medicine, Western Infirmary, Glasgow GIl 6NT. Accepted 4 April 1990 Renal ectopia in the thoracic cavity is very rare, being found in less than 0001% of necropsies,' and most cases occur in males and in the right thoracic cavity2-5 (the liver being supposed to impede migration on the right). We report a case in a girl who had a right thoracic kidney associated with pulmonary hypoplasia and herniation of liver into the thoracic cavity. Case report A 13 year old white girl was referred via the school BCG service after a positive response to the Mantoux test during routine screening. She was apparently fit and well, and denied any respiratory or systemic symptoms. She had no significant past medical history but had been given BCG vaccination at birth in accordance with the policy of the nursing home where she was born. On examination she was of normal stature (height 1 70 m, weight 39 4 kg), and a scar was evident over the left deltoid. The radial pulse was 70/min (regular), blood pressure 90/ 65 mm Hg, and the apex beat 2 cm lateral to the right sternal border in the fourth interspace. Heart sounds were normal but heard maximally over the sternum. The trachea was central but the percussion note was dull in the right mid and lower zones. Breath sounds were quiet but vesicular over that area anteriorly; an area of bronchial breathing was audible posteriorly. Examination of the left hemithorax was normal except for the absence of physiological cardiac dullness. Abdominal examination showed nothing remarkable. Posteroanterior and right lateral chest radiographs (fig 1) showed the heart to be displaced to the right and the right lung to be of reduced volume, with the aortic arch apparently lying to the left. An unusual vessel was seen in the right lower zone with a rounded opacity at the right base posteriorly. The overall appearances were thought consistent with a sequestration and associated hypoplastic lung. The electrocardiogram was within normal limits. Formal pulmonary function testing showed FEV1 and FVC to be 1-4 and 1-5 litres (69% and 65% predicted); total lung capacity was 2 08 litres (70%/ predicted). Thoracic computed tomography (fig 2) confirmed the right lung to be small and of