Situs inversus on flipped and incorrectly labeled chest x-ray

Case contributed by Dr Henry Knipe

Presentation

Upper respiratory tract infection and chest pain.

Patient Data

Age: 30 years
Gender: Female

The x-ray has been mislabelled ("R" label indicates patient's left-hand side; note the left-sided ECG leads) and the study has been loaded onto PACS as mirror image. Situs inversus demonstrated with gastric bubble, apex of the heart and aortic arch on the right. Retrocardiac consolidation consistent with infection. Cardiomediastinal contour is otherwise within normal limits.

If there is prior imaging - remember to always review it. The next chest x-ray is from nine months earlier. 

Dextrocardia and situs inversus is demonstrated, with the stomach bubble/fundus on the right. Right-sided aortic arch. The cardiomediastinal contour is otherwise within normal limits. Lungs and pleural spaces clear.

Case Discussion

This is a good example of the need to always review the prior imaging and if something is not quite right (e.g. misplaced ECG leads), don't dismiss it...

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