An Asymptomatic Intrathoracic Kidney Secondary to a Bochdalek Hernia in a Geriatric Patient

TL;DR

An 84-year-old man had an asymptomatic intrathoracic kidney due to a Bochdalek hernia, found incidentally during imaging for chest pain.

Contribution

This case highlights conservative management as a viable option for asymptomatic adult Bochdalek hernias.

Findings

A right-sided Bochdalek hernia with intrathoracic kidney was found incidentally in an elderly patient.

Conservative management was appropriate due to the absence of symptoms.

Incidental imaging findings can guide clinical decisions in geriatric patients.

Abstract

A Bochdalek hernia is a congenital defect that permits abdominal organs to herniate into the thoracic cavity. While commonly diagnosed in neonates due to symptomatology, it is often found incidentally in adults. The case presents an 84-year-old male from a skilled nursing facility complaining of left-sided chest pain radiating to the left shoulder, accompanied by shortness of breath and nausea. Initially worked up for an acute coronary cause or pulmonary embolism, imaging revealed an incidental right-sided Bochdalek hernia with intrathoracic displacement of the right kidney. Given the absence of gastrointestinal or pulmonary symptoms, the patient was conservatively managed. While surgical repair is preferred for symptomatic Bochdalek hernias in adults, conservative management is a viable option for stable patients. This case highlights the importance of incidental imaging findings in guiding clinical decision-making and patient-focused care.

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