|Year : 2021 | Volume
| Issue : 1 | Page : 206-208
Imaging findings of dextrocardia with situs inversus in covid positive patient: A case to look back
Rohan Kumar Singh, Gaurav Vedprakash Mishra, Megha Manoj, Bhavik Unadkat, Prerna Patwa
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
|Date of Submission||27-Jan-2021|
|Date of Decision||18-Feb-2021|
|Date of Acceptance||08-Mar-2021|
|Date of Web Publication||29-Jul-2021|
Dr. Prerna Patwa
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
Source of Support: None, Conflict of Interest: None
Dextrocardia is a rare congenital developmental anomaly where the heart is located in the right hemithorax with the cardiac apex pointing toward the right. Dextrocardia may be associated with total situs inversus or can also present as an isolated finding. We present very rare interesting case of situs inversus totalis in a 68-year-old male patient who came with complaints of difficulty in breathing and had a history of fever for 4 days. In view of the COVID-19 pandemic, he got his real time polymerase chain reaction done and he turned out to be positive. On the imaging dextrocardia with total situs inversus was detected. Even though for a common man, dextrocardia with total situs inversus is only heart on the right side of the body with transposition of the abdominal organs, viscera, and vasculature but from a medical point of view, the diagnosis holds a lot of importance as it is useful in the detection of conditions like appendicitis and abdominal organ injuries.
Keywords: Computed tomography, dextrocardia, radiography, situs inversus, ultrasonography
|How to cite this article:|
Singh RK, Mishra GV, Manoj M, Unadkat B, Patwa P. Imaging findings of dextrocardia with situs inversus in covid positive patient: A case to look back. J Datta Meghe Inst Med Sci Univ 2021;16:206-8
|How to cite this URL:|
Singh RK, Mishra GV, Manoj M, Unadkat B, Patwa P. Imaging findings of dextrocardia with situs inversus in covid positive patient: A case to look back. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:206-8. Available from: http://www.journaldmims.com/text.asp?2021/16/1/206/322595
| Introduction|| |
A very rare congenital anomaly, situs inversus is characterized by the transposition of the vasculature, viscera, and abdominal organs. When situs inversus is associated with dextrocardia then it is known as situs inversus totalis. Situs inversus totalis is genetically an autosomal recessive condition which is often. Situs inversus may or may not be associated with dextrocardia. Usually, situs inversus is diagnosed accidentally when the patient is undergoing radiographic assessment generally to investigate for any infection or blunt abdominal trauma. Dextrocardia with situs inversus (situs inversus totalis) is a very rare congenital anomaly with an incidence rate of 1/10,000 live births. What is the exact cause for dextrocardia is still not known. Situs inversus has been associated with variable factors such as maternal diabetes, cocaine abuse, congenital heart anomalies, primary ciliary dyskinesia or splenic developmental anomalies and genetic factors. This anomaly is equally found in both males and females. We report a rare congenital anomaly, case of dextrocardia with situs inversus in a 68-year-old man who was COVID-19 positive came with complaints of cough and difficulty in breathing for 3 days.
| Case Report|| |
A 68-year-old male patient visited outpatient department of Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe with chief complaints of cough and difficulty in breathing for 3 days. The patient also had a history of fever for 4 days. In view of COVID-19 pandemic, he got real-time polymerase chain reaction done and turned out to be positive.
On X-ray, it was seen that cardiac apex was located on the right side of the thorax, fundic gas bubble was seen under the right hemidiaphragm and descending aorta was also on the right side. While the liver was located on the left side of the patient's body. X-ray showed normal lung parenchyma. Gas in large bowel with peculiar haustrations pattern most likely the splenic flexure was noted in the right hypochondriac region. All these radiograph findings are not usual findings.
In view of the COVID-19 pandemic on computed tomography (CT) severity score of the patient was 4/25. In comparison to normal situs solitus images obtained on CT scan showed that abdominal organs, vasculatures and even lobes of lungs were located just opposite to normal anatomical position. The stomach was located in the right hypochondriac region with fundic gas bubble, the liver with gall bladder was located in the left hypodhondriac region, mirror image to its usual anatomical location spleen was seen in adjacent to the stomach. In the region of the splenic hilum, pancreatic tail was seen and these structures were located on the right side of the body. While rest of the pancreas that is head and uncinate process of the pancreas was left of the abdominal aorta.
Similar findings were seen on ultrasound, liver along with gallbladder was located in hypochondriac region on left while spleen with the tail of pancreas in splenic hilum was seen in hypochondriac region on right. Both major artery and vessels were seen opposite to its normal location that is descending aorta, the abdominal aorta was seen on the right side of the midline and the inferior vena cava was on the left of the midline. The head and uncinate process of the pancreas with gastroduodenal artery was seen on the left of the midline in the upper epigastric region.
All the findings was explained thoroughly to him, the patient was counseled properly so that he do not have any fear about the same. To know more about this rare congenital anomaly proper consent of the patient was taken to go for chest radiography and for the same no extra charges were taken from the patient [Figure 1], [Figure 2], [Figure 3], [Figure 4].
|Figure 1: Chest radiograph erect film showing the heart in right hemithorax with apex of the heart toward right. Ascending aorta, aortic knuckle, and arch of the aorta is on the right side while descending aorta on left. Abdominal erect radiograph shows homogenous opacification under left hemidiaphragm suggestive of liver on left side and there is elevation of the left hemidiaphragm. Gas in ascending and transverse colon with gastric air bubble is seen on the right side just below right hemidiaphragm|
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|Figure 2: Axial computed tomography scan of situs inversus with heart in right hemi-thorax. On caudal sections situs - branches of pulmonary artery arising from right side and ascending aorta arising from left side are seen|
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|Figure 3: Reconstructed coronal computed tomography scan images showing heart in right hemithorax, liver is seen on left upper quadrant and fundic gas is seen on right upper quadrant. Lung window showing steeper left main bronchus in comparison to right main bronchus. And right lung had two lobes and left lung had three lobes|
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|Figure 4: Grey scale ultrasound image longitudinal plane shows: the spleen is in the right hypochondrium region just below right hemidiaphragm in close relation to the right kidney. And liver on a left side instead of its normal anatomical position that is on right-hypochondrium|
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| Discussion|| |
Situs inversus is a very rare congenital developmental anomaly with the occurrence of 1 in 8000 to 1 in 25,000 patients. There is no sex predilection for situs inversus so incidence of male-to-female is 1:1. Situs inversus can be associated with dextrocardia and it is known as situs inversus totalis. Dextrocardia means the heart is located in the right hemithorax with the cardiac apex pointing toward the right side. In relation to dextrocardia, there can be different positions of abdominal visceral organs. Dextrocardia with normal anatomical positions of abdominal organs is known as situs solitus and if with dextrocardia all abdominal organs are transposed mirror image to normal anatomical position it is known as situs inversus totalis (situs in my patient). It has been noted that dextrocardia with situs inversus has a low incidence of association with congenital heart disease however dextrocardia with normal situs has a higher association with cardiac anomalies like atrial septal defect, ventricular septal defect, and transposition of the great vessels in 90%–95% of cases., Situs inversus may be associated with Kartagener syndrome (primary ciliary dyskinesia) and other congenital anomalies like the absence of the spleen, multiple spleens, horseshoe kidney, unusual location of kidney from its normal anatomical position (ectopic kidney). Person having dextrocardia with situs inversus in absence of other congenital anomalies usually has normal life expectancy. In presence of cardiac anomalies, life expectancy is decreased which further depends on the defect severity. The exact cause of situs inversus totalis is unknown, however, dextrocardia is associated with an autosomal recessive gene with incomplete penetrance. Situs inversus has been associated with variable factors such as maternal diabetes, cocaine abuse, congenital heart anomalies, primary ciliary dyskinesia or splenic developmental anomalies, and genetic factors.
| Conclusions|| |
The prevalence of situs inversus is less than 1 in 10,000 people and its prevalence varies among different populations. There are many etiologic theories and factors that lead to situs inversus totalis. Imaging modalities like magnetic resonance imaging, CT, or ultrasonography can be advised for diagnosing situs inversus totalis in the suspected patient. These imaging modalities also rule out any chance of situs ambiguous. Health workers should ask their patients for regular routine medical examination so that this rare congenital anomaly could be identified so that wrong diagnoses can be prevented and this will further decrease patient death due to delay in management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]