Percutaneous Nephrolithotomy in an Intrathoracic Kidney: A Rare Anatomical Variant With a Successful Outcome.

Thoracic kidney is the rarest form of renal ectopia and is usually detected incidentally. The coexistence of nephrolithiasis within an intrathoracic kidney associated with a congenital diaphragmatic hernia is extremely uncommon. We report a 32-year-old woman with a left intrathoracic kidney containing a large staghorn calculus herniating through a congenital diaphragmatic defect. A percutaneous nephrostomy was placed under ultrasound and computed tomography (CT) guidance, and percutaneous nephrolithotomy (PCNL) was performed through the 9th intercostal space using a pneumatic lithotripter, achieving complete clearance. The patient had an uneventful recovery with no respiratory complications. This rare case demonstrates that with meticulous imaging-based planning and multidisciplinary collaboration, minimally invasive management such as PCNL can be safely and effectively performed in intrathoracic kidneys with complex calculi.