Superior lumbar hernia with incarcerated kidney

Case contributed by Dr Domenico Nicoletti

Presentation

Painful growing mass on left lower back for the past 10 months. No history of previous procedures or trauma was reported. Physical examination showed a left lumbar tender mass which increased especially during Valsalva maneuver, just below the 12th left rib.

Patient Data

Age: 80 years
Gender: Male

In the left upper lumbar triangle there is a protrusion of retroperitoneal fat with incarceration of the ipsilateral kidney. Thinned latissimus dorsi muscle and disrupted thoracolumbar fascia. There is a modest pleural effusion on the right.  At the bladder base, on the right, there's a papillary lesion with enhancement, near the ureteral orifice.

Case Discussion

Back lumbar hernias are wall defects of the lumbar area, a region bound by the external oblique muscle laterally, the erector spinae muscle medially, the iliac crest inferiorly and the 12th rib superiorly. The region is divided into two spaces, the superior, also referred to as the Grynfeltt-Lesshaft triangle, and the inferior space, called Petit’s triangle. Contents of this upper lumbar hernia may include retroperitoneal organs such as the kidneys, and ascending or descending colon, intraperitoneal organs such as the small bowel, stomach, and spleen, and retroperitoneal or omental adipose tissue. Risk factors are elderly, obesity, muscular atrophy, and chronic obstructive pulmonary disease (COPD) or any condition that causes increasing intra-abdominal pressure.

Case courtesy: Dr.ssa Chiara Gennari

Radiographer: TSRM Fabio Imola

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