Case contributed by Jane McEniery
Diagnosis certain


"Assess line and tube position". Additional history withheld.

Patient Data

Age: 1 year
Gender: Male

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.

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.

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