# Percutaneous Nephrolithotomy in an Intrathoracic Kidney: A Rare Anatomical Variant With a Successful Outcome

## TL;DR

A rare case of a kidney inside the chest successfully treated with a minimally invasive stone removal procedure.

## Contribution

Demonstrates the safe use of percutaneous nephrolithotomy in a rare intrathoracic kidney with a large kidney stone.

## Key findings

- PCNL was successfully performed in an intrathoracic kidney with a staghorn calculus.
- The procedure was completed without respiratory complications.
- Multidisciplinary planning enabled safe minimally invasive treatment of a rare anatomical variant.

## Abstract

Thoracic kidney is the rarest form of renal ectopia and is usually detected incidentally. The coexistence of nephrolithiasis within an intrathoracic kidney associated with a congenital diaphragmatic hernia is extremely uncommon.

We report a 32-year-old woman with a left intrathoracic kidney containing a large staghorn calculus herniating through a congenital diaphragmatic defect. A percutaneous nephrostomy was placed under ultrasound and computed tomography (CT) guidance, and percutaneous nephrolithotomy (PCNL) was performed through the 9th intercostal space using a pneumatic lithotripter, achieving complete clearance. The patient had an uneventful recovery with no respiratory complications.

This rare case demonstrates that with meticulous imaging-based planning and multidisciplinary collaboration, minimally invasive management such as PCNL can be safely and effectively performed in intrathoracic kidneys with complex calculi.