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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.
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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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- 2. Yokoyama T, Copeland N, Jenkins N, Montgomery C, Elder F, Overbeek P. Reversal of Left-Right Asymmetry: A Situs Inversus Mutation. Science. 1993;260(5108):679-82. doi:10.1126/science.8480178
- 3. Applegate K, Goske M, Pierce G, Murphy D. Situs Revisited: Imaging of the Heterotaxy Syndrome. Radiographics. 1999;19(4):837-52; discussion 853-4. doi:10.1148/radiographics.19.4.g99jl31837
- 4. Julia A. McMillan, Ralph D. Feigin, Catherine DeAngelis et al. Oski's Pediatrics. (2006) ISBN: 9780781738941 - Google Books
- 5. Andy Adam. Grainger & Allison's Diagnostic Radiology. (2015) ISBN: 9780702042959 - Google Books
- 6. Kwon S & Shin S. Incidental Adult Polysplenia with Situs Inversus, Interrupted Inferior Vena Cava with Azygos Continuation, Patent Ductus Arteriosus, and Aortic Branches Variations: A Case Report. J Thorac Dis. 2018;10(2):E138-41. doi:10.21037/jtd.2018.01.128 - Pubmed
- 7. Reddy A, Paramasivam S, Alexander N, Abhilash, Ravisankar V, Thillai M. Management of a Patient with Situs Inversus Totalis with Acute Cholecystitis and Common Bile Duct Stones: A Case Report. Int J Surg Case Rep. 2014;5(11):821-3. doi:10.1016/j.ijscr.2014.08.004 - Pubmed