Thoracic Kidney

A 74-year-old man with diabetes and hypertension was referred to the hospital for evaluation of a mass in the right side of the chest, identified on a radiograph (Panel A, arrows). He reported no pulmonary problems and no history of chest trauma. Physical examination was unremarkable. Reformatted coronal (Panel B) and sagittal (Panel C) computed tomographic scans show the right kidney (large arrows) and part of the liver protruding above the diaphragm (small arrows) and into the posteromedial aspect of the right hemithorax through the foramen of Bochdalek (arrowheads indicate the defective fusion of the diaphragm).

Thoracic kidney is a rare congenital anomaly. Because of the location of the liver, thoracic kidney on the right side is much less common than thoracic kidney on the left side. Thoracic kidney is twice as common in men as in women. Typically, the presence of a thoracic kidney is asymptomatic and requires no intervention, as in this case.

Triad of Kartagener syndrome

 A 14-year-old boy presents with a history of chronic sinusitis and frequent pneumonias. On physical examination, the patient has normal vital signs and is afebrile. He has mild frontal and maxillary sinus tenderness with palpation. Transillumination of the sinuses is normal. Heart sounds are best heard on the right side of the chest. The boy is coughing copious amounts of yellowish sputum. Which of the following is the most likely diagnosis?

• a.Cystic fibrosis
• b.Kartagener syndrome
• c.Pulmonary dysplasia
• d.Tuberculosis
• e.Pulmonary hypertension

 The answer is b."Kartagener syndrome"
Kartagener syndrome is the inheritable disorder of dextrocardia, chronic sinusitis (with the formation of nasal polyps), and bronchiectasis. Patients may also present with situs inversus.The disorder is due to a defect that causes the cilia within the respiratory tract epithelium to become immotile. Cilia of the sperm are also affected.

Frontal and Chest x-ray showing dextrocardia "the typical radiographic sign of Kartagener's syndrom" and bronchiectasis.

External cephalic version (ECV) to turn a breech baby

Indication and Technique of Buried Intradermal Sutures

Indication:

Buried Intradermal Sutures technique is useful for wide, gaping wounds and when it is difficult to evert the skin edges. When buried intradermal sutures are placed properly, they make skin closure much easier. The purpose of this stitch is to line up the dermis and thus enhance healing.
It is termed buried as the knot needs to be as deep into the tissues as possible so that it does not come up through the epidermis and cause irritation and pain.

Technique:

-By using a cutting needle and absorbable material Start just under the dermal layer and come out below the epidermis.
You are going from deep to more superficial tissues.

-Now the technique becomes a bit challenging. You need to enter the skin on the opposite side at a depth similar to where you exited the skin on the first side, just below the epidermis. To do so, you should position the needle with the tip pointing down and pronate your wrist to get the correct angle. It will help to use the forceps (in the other hand) to hold up the skin. The needle should come out of the tissues below the dermis. Try to get as little fat in the stitch as possible; it does not contribute to the suture.

-Finnaly Tie the suture.