A 61-year-old man who was a psychiatric patient and an alcoholic was admitted to hospital after a fall in his bathroom. He showed signs of hemorrhagic shock, and CT scans showed the presence of the right kidney and part of the right retroperitoneum in the right hemithorax, surrounded by liquid. Surgery showed that the right hemidiaphragm was intact and that no intraabdominal viscera prolapsed into thoracic cavity. The bleeding in the right retroperitoneum was evacuated. The surgical report also stated that “the right kidney and ureter were explored and no injuries or active bleeding were found”. The patient died the third day after admission. Autopsy revealed a livid swelling covered with parietal pleura in the right half of the thoracic cavity, behind the costophrenic sinus, about 20 × 15x12 cm in size, filled with about 1500 ml of blood, with ectopic right kidney in the right half of the thorax, slightly rotated posteriorly and downwards. The kidney was smaller (80 g in weight), compared to the normally positioned enlarged left kidney (300 g). The right hemidiaphragm was also intact with small Bochdalek’s foramen behind the posterior edge, with communication between the right retropleural and retroperitoneal spaces, through which intact elongated right renal artery (15 cm), vein (14 cm) and ureter were passing. The cause of death was hemorrhagic shock due to retroperitoneal bleeding, with coagulation disorder as possible contributing factor. Intrathoracic kidneys may pose many diagnostic and management dilemmas for clinicians and pathologists. Association between a Bochdalek hernia and an intrathoracic renal ectopia is very rare and may be confusing for doctors in different clinical situations.

一名 61 岁的精神病患者和酗酒者在浴室摔倒后被送往医院。他表现出失血性休克的迹象，CT 扫描显示右半胸存在右肾和部分右腹膜，被液体包围。手术显示右侧膈肌完好，无腹腔内脏器脱出胸腔。排出右侧腹膜后的出血。手术报告还称，“检查了右肾和输尿管，没有发现损伤或活动性出血”。患者入院后第三天死亡。尸检显示右半胸腔、肋膈窦后面有一个被壁层胸膜覆盖的青色肿块，大小约 20 × 15x12 cm，充满约 1500 ml 血液，右半胸异位右肾，略微向后和向下旋转。与正常位置增大的左肾（300 克）相比，肾脏较小（80 克重）。右侧膈肌也完好，后缘后方有小Bochdalek孔，右侧胸膜后间隙与腹膜后间隙相通，完整的细长右肾动脉（15 cm）、静脉（14 cm）和输尿管穿过该间隙。死因为腹膜后出血引起的失血性休克，凝血功能障碍可能是致死原因。胸内肾脏可能会给临床医生和病理学家带来许多诊断和管理难题。