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Situs Inversus Totalis

Shogan PJS - MedPix (2008)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Situs Inversus Totalis

History: 87 year old man with complaint of a cough.

Findings: Chest radiography demonstrates dextrocardia with the cardiac apex pointing to the right. There is a right-sided aortic arch, associated with slight deviation of the distal trachea to the left. A loop of bowel projects in the right upper quadrant of the abdomen. The minor fissure is on the left side. There is no evidence of bronchiectasis. Contrast enhanced CT at the level of the origin of the great vessels demonstrates mirror-image branching of the great vessels; a left-sided superior vena cava; and a contrast filled esophagus posterior to the trachea. Contrast enhanced CT at the level of the diaphragm demonstrates reversal of the normal cardiac anatomy. Note that the cardiac apex and descending aorta are on the right, and the inferior vena cava is on the left side. Contrast enhanced CT of the upper abdomen show mirror-image anatomy of the viscera. The liver, gallbladder, and inferior vena cava are all left-sided. The stomach, spleen, and aorta are right-sided structures. Contrast enhanced CT at the level of the iliac crests demonstrates a left-sided inferior vena cava, and a right-sided abdominal aorta. Maximal Intensity Projection demonstrates the right-sided aortic arch, left-sided superior vena cava, dextrocardia, right-sided contrast filled stomach, and left sided liver, and gallbladder. Contrast enhanced CT with lung windowing and leveling, demonstrates normal lung parenchyma without evidence of bronchiectasis. Additionally, mirror-image anatomy is evident with a left-sided minor fissure, the pulmonary outflow tract and aortic root are in reversed position, and the left pulmonary artery is seen crossing the mediastinum anterior to the esophagus and left main bronchi.

Ddx: • False-positive on Radiography: Technologists or radiologist’s inattention to labeling of the radiograph. The technologist prepares for a PA radiograph, labels the image, but images the patient in an AP projection. • False-Positive on CT: Depending on how the patient is positioned into the CT scanner, head first or feet first, supine or prone, and if incorrectly marked by the technologist, the left-right orientation will be displayed erroneously suggesting situs inversus. • Situs Inversus • Situs Inversus totalis • Dextrocardia • Situs ambiguous or heterotaxy • Kartagener Syndrome

Dxhow: Imaging findings are diagnostic situs

No MeSH data available.


PA chest radiograph demonstrates dextrocardia with the cardiac apex pointing to the right.  There is a right-sided aortic arch, associated with slight deviation of the trachea to the left.   A loop of bowel projects in the right upper quadrant of the abdomen. The minor fissure is left sided.  There is no evidence of bronchiectasis.
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MPX1628_synpic41583: PA chest radiograph demonstrates dextrocardia with the cardiac apex pointing to the right. There is a right-sided aortic arch, associated with slight deviation of the trachea to the left. A loop of bowel projects in the right upper quadrant of the abdomen. The minor fissure is left sided. There is no evidence of bronchiectasis.


Situs Inversus Totalis

Shogan PJS - MedPix (2008)

PA chest radiograph demonstrates dextrocardia with the cardiac apex pointing to the right.  There is a right-sided aortic arch, associated with slight deviation of the trachea to the left.   A loop of bowel projects in the right upper quadrant of the abdomen. The minor fissure is left sided.  There is no evidence of bronchiectasis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1628&req=5

MPX1628_synpic41583: PA chest radiograph demonstrates dextrocardia with the cardiac apex pointing to the right. There is a right-sided aortic arch, associated with slight deviation of the trachea to the left. A loop of bowel projects in the right upper quadrant of the abdomen. The minor fissure is left sided. There is no evidence of bronchiectasis.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Situs Inversus Totalis

History: 87 year old man with complaint of a cough.

Findings: Chest radiography demonstrates dextrocardia with the cardiac apex pointing to the right. There is a right-sided aortic arch, associated with slight deviation of the distal trachea to the left. A loop of bowel projects in the right upper quadrant of the abdomen. The minor fissure is on the left side. There is no evidence of bronchiectasis. Contrast enhanced CT at the level of the origin of the great vessels demonstrates mirror-image branching of the great vessels; a left-sided superior vena cava; and a contrast filled esophagus posterior to the trachea. Contrast enhanced CT at the level of the diaphragm demonstrates reversal of the normal cardiac anatomy. Note that the cardiac apex and descending aorta are on the right, and the inferior vena cava is on the left side. Contrast enhanced CT of the upper abdomen show mirror-image anatomy of the viscera. The liver, gallbladder, and inferior vena cava are all left-sided. The stomach, spleen, and aorta are right-sided structures. Contrast enhanced CT at the level of the iliac crests demonstrates a left-sided inferior vena cava, and a right-sided abdominal aorta. Maximal Intensity Projection demonstrates the right-sided aortic arch, left-sided superior vena cava, dextrocardia, right-sided contrast filled stomach, and left sided liver, and gallbladder. Contrast enhanced CT with lung windowing and leveling, demonstrates normal lung parenchyma without evidence of bronchiectasis. Additionally, mirror-image anatomy is evident with a left-sided minor fissure, the pulmonary outflow tract and aortic root are in reversed position, and the left pulmonary artery is seen crossing the mediastinum anterior to the esophagus and left main bronchi.

Ddx: • False-positive on Radiography: Technologists or radiologist’s inattention to labeling of the radiograph. The technologist prepares for a PA radiograph, labels the image, but images the patient in an AP projection. • False-Positive on CT: Depending on how the patient is positioned into the CT scanner, head first or feet first, supine or prone, and if incorrectly marked by the technologist, the left-right orientation will be displayed erroneously suggesting situs inversus. • Situs Inversus • Situs Inversus totalis • Dextrocardia • Situs ambiguous or heterotaxy • Kartagener Syndrome

Dxhow: Imaging findings are diagnostic situs

No MeSH data available.