Focal eventration of the diaphragm with transthoracic kidney is a very rare condition. It is usually asymptomatic and often revealed as an incidental finding on imaging studies. We presented a case of previously undiagnosed focal eventration of left hemidiaphragm with transthoracic left kidney confused with traumatic diaphragmatic hernia. Differentiation of these two conditions is important as each were managed differently. A traumatic diaphragmatic hernia needs early surgical intervention whereas no treatment was required for focal diaphragmatic eventration in most cases. Diagnostic laparoscopy confirmed the findings in this case and the patient was managed conservatively.
A previously healthy 52-year-old man had a chest radiograph for medical check-up and found to have a right-sided aortic arch. Computed tomography of the thorax revealed a right-sided aortic arch with aberrant left subclavian artery originated from Kommerell's diverticulum. Barium swallow examination showed compression of the posterior wall of the esophagus. He was asymptomatic and no surgical intervention was performed.
Ureteral triplication is a rare congenital anomaly of the urinary tract. We report a case of ureteral triplication with contralateral partial kidney duplication in a patient with right loin pain. The development and types of ureteral triplication and the features of type 2 ureteral triplication on intravenous urography and magnetic resonance urography are described.
Malignancy is a significant long-term complication of successful renal transplantation. Not only the rate is higher but also cases are highly aggressive. We report a case of metastatic, small cell, neuroendocrine tumor in a post-renal transplant patient with progressive left inguinal nodes and right lumbar swellings. He had a remarkably elevated serum lactate dehydrogenase levels with multiple metastatic masses in the left inguinal, left iliac fossa, and right lower abdominal wall on abdominal computed tomography scan. Excisional biopsy of a left inguinal node revealed extensive infiltration with malignant cells in it. Immunohistochemistry staining was positive for synaptophysin, prostatic specific antigen, and CD56. While the primary small cell carcinoma of genitourinary organs is rare, the case illustrates the highly aggressive nature of the disease in a kidney transplant recipient.
Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).