Objective: Bochdalek hernias are congenital posterolateral diaphragmatic defects arising from failure of the pleuroperitoneal foramina to fuse during embryogenesis, permitting intra-abdominal viscera to herniate into the thoracic cavity.^[1,2] Intrathoracic kidney is an exceptionally uncommon form of renal ectopia, constituting fewer than 5% of all ectopic kidney placements.^[3] The simultaneous occurrence of both anomalies in a single patient is exceedingly rare, with fewer than 100 adult cases documented in the global literature.^[4] The majority of such cases are identified incidentally; a conservative approach is advocated for asymptomatic individuals.

Case Presentation: A 50-year-old male presented with easy fatigability, exertional dyspnea, and palpitations, and was subsequently diagnosed with severe iron deficiency anemia (Hb: 7.5 gm/dL). Chest radiograph disclosed a large homogeneous opacity superimposed on the right hemidiaphragm, raising differential diagnoses including lower-lobe pulmonary pathology, pleural disease, subdiaphragmatic mass or abscess, and elevated hemidiaphragm. Electrocardiography revealed sinus tachycardia at 102 beats/min; 2D echocardiography was unremarkable. Abdominal ultrasonography failed to identify the right kidney in the renal fossa or pelvic cavity. Contrast-enhanced computed tomography (CECT) of the abdomen confirmed a right-sided Bochdalek hernia with a normal-calibre intrathoracic right kidney. ^[5,6] Renal function tests and intravenous urography established bilaterally normal renal function.