Situs inversus

Last revised by Yuranga Weerakkody on 14 Jul 2023

Situs inversus, (rare plural: sitūs inversi) short form of the Latin “situs inversus viscerum”, is a term used to describe the inverted position of chest and abdominal organs.

The condition is called situs inversus totalis when there is a total transposition of abdominal and thoracic viscera (mirror image of internal organs normal positioning). Normal positioning of the organs - as found in the majority of individuals is called situs solitus.

Much more rarely is transposition of the abdominal organs with a 'normal' left-sided heart, known variously as situs inversus incompletus, situs inversus partialis, or simply situs inversus with levocardia 7.

Situs inversus is usually associated with dextrocardia (true mirror image) with only 3-5% incidence of congenital heart disease, most commonly transposition of the great vessels. Of these patients, 80% have a right-sided aortic arch. Situs inversus with levocardia (which is much rarer: 0.00005%) congenital heart disease is found in 95% of patients 4.

Up to 20% of patients with situs inversus can have Kartagener syndrome 3 which comprises a subgroup of primary ciliary dyskinesia.

Situs inversus can be associated with both asplenia 5 or polysplenia (rarely) 6.

Complete situs inversus is associated with the absence of inferior vena cava 5.

Imaging features on chest radiograph to be evaluated are:

  • location of the heart apex
  • location of the aortic arch
  • locations of stomach bubble and liver

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