This patient presented with collapse and upper GI bleed. Examination revealed diffuse upper abdominal tenderness.

CT of the abdomen and pelvis did not identify a cause for the patients symptoms.

An incidental note was made of multiple features of left sided heterotaxy syndrome - multiple aberrant nodules of splenic tissue, an azygous continuation of the IVC, midgut malrotation.

This prompted review of previous imaging to identify further features of left sided heterotaxy syndrome.

A CTPA from 10 years earlier (above) was reviewed and demonstrated bilateral bilobed lungs.

Other features (not demonstrated in this case) of left sided heterotaxy include TAPVR/PAPVR; Truncated pancreas; biliary abnormalities; midline liver; renal abnormalities.

Life expectancy for left sided heterotaxy is better than for its right sided counterpart due to association with less severe cardiac abnormalities.