Presentation
"Assess line and tube position". Additional history withheld.
Patient Data
Age: 1 year
Gender: Male
From the case:
Heterotaxy
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/76287/annotated_viewer_json?c=1669403172\u0026lang=us"}
Chest x ray:
- Left upper limb PICC remains to the left of midline, likely within a left sided SVC.
- Nasogastric tube passes to a right sided stomach.
- Heart size within normal limits.
- Mild perihilar interstitial thickening. No confluent consolidation. No pleural effusion.
- No visible vertebral abnormality.
From the case:
Heterotaxy
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/76418/annotated_viewer_json?c=1669403172\u0026lang=us"}
CT Chest:
- Confirms the presence of a bilateral SVC.
- Normal veno-atrial and atrio-ventricular connections.
- Normal bronchial branching pattern (eparterial bronchus on the right, hyparterial bronchus on the left)
- Atelectasis in the lung bases, likely relating to anesthetic.
- ETT tip in the trachea; NGT tip in the stomach.
CT Abdomen:
- Stomach on the right
- Liver on the left
- Polysplenia on the left
- Crossed fused renal ectopia, with the kidneys on the right
- Ascites
Case Discussion
Complex anatomy is demonstrated in this case of a disorder of laterality. There is a disorder of visceral situs and polysplenia, however the bronchial anatomy is normal, thus this does not represent isomerism.
Case contributed by Dr Jennifer Powell.
Unable to process the form. Check for errors and try again.