Dextrocardia with situs inversus totalis

Case contributed by Desiree Rassa Eshraghi

Presentation

Unexplained weight loss, urinary incontinence, and anemia. Past history of fractured ribs and still healing proximal humerus fracture.

Patient Data

Age: 65 years
Gender: Male

Considering the side marker is correct, findings are consistent with dextrocardia and situs inversus with the aortic knob, cardiac apex and the stomach/proximal small bowel in the right lower hemithorax and right upper quadrant.

Much elevated right hemidiaphragm with evidence of bowel and likely stomach herniation in the right lower hemithorax.

The heart appears normal sized without pulmonary vascular congestion.

Bilateral right greater than left old healed rib fracture deformities. Partially visualized intramedullary nail and screw transfixed in the proximal left humerus appears intact. No free air in the upper abdomen.

Case Discussion

Dextrocardia refers to when the heart is unusually positioned/flipped to the right side of the chest. Situs inversus, also a rare congenital condition, is when the body's internal organs are someway rearranged from their standard placements. Inversus totalis is defined by both dextrocardia and situs inversus. Most discover they have this often-asymptomatic condition upon an unrelated medical visit. 

This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Pediatric Radiologist,
Olive View - UCLA Medical Center.

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