Presentation
Chest and abdominal pain with clinical suspicion of gastrointestinal perforation/obstruction.
Patient Data
Chest x-ray (PA view):
Dextrocardia and right-sided aorta are demonstrated. The stomach bubble is seen in the right upper abdominal region.
Abdominal x-ray:
Situs inversus of the abdominal viscera as evidenced by a triangular soft tissue mass (liver) in the left upper quadrant.
Situs inversus on frontal abdominal radiograph. The liver edge is clearly visible (solid white line) with the left kidney adjacent to it. Left sided hepatic flexure of colon (asterisk) is noted.
Case Discussion
Confirmation was sought from the radiographer to ensure that the radiograph images were not erroneously flipped during processing and the marker was not placed on the incorrect side.
This case highlights key abdominal structures that one should aim to identify when interpreting radiographs to avoid confusing anatomical variants with pathology. This is particularly useful in the absence of an associated chest radiograph which may demonstrate an obvious dextrocardia or in the case of incomplete situs inversus.
Acknowledgements to colleagues contributing to the cases:
Dr Carla Goncalves,
Dr Andrew Tanqueray,
Dr Kumar Venu Ramavathu
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