A Rare Cause of Hydroenphrosis; Case Presentation of an Intrathoracic Herniated Ureter

Abstract

Background
Thoracic ureteric herniation is an uncommon finding with a varying presentation. Since its first documen-tation in 1958, few case reports have been published, and there is no consensus on its management. This condition is typically asymptomatic, with most cases identified incidentally from cross-sectional imaging or discovered intra-operatively.
As a result of differing presentations and a lack of consensus or evidence of best practice, this rare finding’s management is not defined. This can range from adopting a conservative approach to more invasive measures such as ureteric stenting or pyeloplasty to repair the thoracic hernia.
The authors present a case of thoracic ureteric herniation in a 74-year-old male presenting with right-sided abdominal pain. This patient was known to have a diaphragmatic hernia following pulmonary fibrosis investigations and chronic obstructive pulmonary disease (COPD). At presentation, there was acute kidney injury (AKI), and subsequent computed topography (CT) demonstrated right-sided hydronephrosis and perinephric fat stranding. This was caused by ureteric obstruction with a transition point at the site of thoracic herniation. The patient was successfully managed with retrograde ureteric stent insertion.
This case report aims to highlight variance in the presentation of ureteric thoracic herniation and discuss management options. There is no consensus on management for this condition and choices dependant on specific symptoms and patient factors to the best of our knowledge.