PMC6304889_01
Axial section of both hemithoraces. Bowel loops occupying the right hemithorax.
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Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax (Figures 1-6); uniform and continuous diaphragmatic elevation throughout the hemithorax (Figures 5 and 6); discrete mediastinal displacement caused by the right kidney (Figure 3); and hepatic displacement towards the left hemiabdomen causing gastric compression (Figure 4).
Sagittal section of the right hemithorax showing occupation by intestinal loops and mesentery.
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Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax (Figures 1-6); uniform and continuous diaphragmatic elevation throughout the hemithorax (Figures 5 and 6); discrete mediastinal displacement caused by the right kidney (Figure 3); and hepatic displacement towards the left hemiabdomen causing gastric compression (Figure 4).
Axial section with the kidney in a posterior position and mild mediastinal compression.
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Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax (Figures 1-6); uniform and continuous diaphragmatic elevation throughout the hemithorax (Figures 5 and 6); discrete mediastinal displacement caused by the right kidney (Figure 3); and hepatic displacement towards the left hemiabdomen causing gastric compression (Figure 4).
Notable hepatic displacement towards the left hemiabdomen that causes gastric compression.
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Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax (Figures 1-6); uniform and continuous diaphragmatic elevation throughout the hemithorax (Figures 5 and 6); discrete mediastinal displacement caused by the right kidney (Figure 3); and hepatic displacement towards the left hemiabdomen causing gastric compression (Figure 4).
Sagittal section showing the occupation in a posterior situation of the kidney with the pedicle in the right hemithorax.
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Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax (Figures 1-6); uniform and continuous diaphragmatic elevation throughout the hemithorax (Figures 5 and 6); discrete mediastinal displacement caused by the right kidney (Figure 3); and hepatic displacement towards the left hemiabdomen causing gastric compression (Figure 4).
Contrast coronal section showing both hemithoraces. Lung parenchyma collapsed in the right hemithorax and occupied by the small intestine, right colon, mesentery, right kidney, and its corresponding pedicle. Normal left hemithorax.
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Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax (Figures 1-6); uniform and continuous diaphragmatic elevation throughout the hemithorax (Figures 5 and 6); discrete mediastinal displacement caused by the right kidney (Figure 3); and hepatic displacement towards the left hemiabdomen causing gastric compression (Figure 4).
The right kidney and its respective pedicle in the posterior intrathoracic situation.
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The pedicle of the intrathoracic right kidney ran through the foramen of Bochdalek (Figure 7).
Incision of the laminated and elongated hemidiaphragm with the presence of muscle fibers.
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A posterolateral thoracotomy was continued at the level of the seventh intercostal space, with the hemidiaphragm being thinned, although with moderate thickness of muscle fibers (Figure 8).
Suture of the hemidiaphragmatic defect. The kidney in the posterior view.
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This was safely performed given the proximity of the peritoneal viscera (Figure 9).
Mesh placement on the hemidiaphragm fixed in the anterolateral position. Note that it surrounds the kidney posteriorly since it remained in the intrathoracic position.
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A dual mesh of polypropylene-PTFE was placed for reinforcement and fixed at the level of diaphragmatic periphery (Figure 10).
Postoperative radiological view of both hemithoraces, showing right lung expansion, renal silhouette, and the hemidiaphragmatic line. Central trachea and normal left hemithorax.
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The chest radiograph showed expansion of the hemidiaphragm, pulmonary field, and residual renal silhouette in the intrathoracic position (Figure 11).