The Lost Kidney: Ultrasound Diagnosis of Adult Bochdalek Hernia With Renal Herniation and Abdominal Aortic Aneurysm

Adult Bochdalek hernia (BH) with left renal herniation is clinically rare and has an insidious onset, rendering it prone to misdiagnosis. We report a case of a 77-year-old male patient who presented with an abdominal pulsatile mass in the absence of respiratory symptoms. Ultrasonography revealed a giant abdominal aortic aneurysm and additionally identified renal echogenicity on the left side of the heart, with a normally positioned spleen. Contrast-enhanced CT demonstrated herniation of the left kidney and a portion of the bowel into the thoracic cavity, along with a giant abdominal aortic aneurysm and multiple atherosclerotic ulcers of the iliac arteries. Ultrasonography is valuable for initial screening, while contrast-enhanced CT defines diaphragmatic defect, ectopic-kidney rotational malformation, and elongated renal pedicle, providing critical evidence for definitive diagnosis.