Heterotaxy
Presentation
"Assess line and tube position". Additional history withheld.
Patient Data
Age: 1 year
Gender: Male
From the case:
Heterotaxy
X-ray
Frontal
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
CT
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Axial C+ arterial phase
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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