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Diagnosis
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Finding Sources
Finding Sources
Reading File
Diagnosis: Dextrocardia with Situs Inversus Totalis
Key Radiological Findings on This Chest PA X-ray
| Feature | Finding |
|---|---|
| Cardiac apex | Points to the right (right hemithorax) |
| Gastric air bubble | Visible on the right lower chest/abdomen (right-sided stomach) |
| Liver | Silhouette on the left |
| Lung fields | Clear bilaterally, no consolidation, no effusion |
| Costophrenic angles | Sharp and clear |
| Mediastinum | No widening |
| Trachea | Midline |
| Bones | No fractures or lesions |
Note: The "R" marker confirms right-sided positioning of the cardiac apex - this is not a film inversion artifact.
Diagnosis
Dextrocardia with Situs Inversus Totalis
- The heart lies in the right hemithorax with the apex pointing right
- Abdominal viscera are mirror-imaged: stomach on the right, liver on the left
- This is a "complete mirror-image" arrangement - situs inversus totalis
Clinical Pearls
Dextrocardia + Situs Inversus Totalis:
- Heart usually functions normally - often found incidentally
- Heart sounds are louder on the right side of the chest
- Liver is palpable on the left
- ECG shows: inverted P and T waves in lead I, negative QRS in lead I, reversed aVR/aVL pattern, mirror-image R-wave progression across precordial leads
Contrast with Dextrocardia + Situs Solitus:
- Ventricles are inverted but NOT the viscera - associated with severe congenital cardiac malformations
Important associations to screen for:
- Kartagener syndrome (primary ciliary dyskinesia): situs inversus + bronchiectasis + chronic sinusitis + male infertility (seen in ~25% of situs inversus cases)
- Echocardiogram should be performed to confirm normal intracardiac anatomy
Management: If isolated situs inversus with normal cardiac function - no specific treatment needed. Echocardiogram is recommended to ensure intracardiac anatomy is normal.
- Goldman-Cecil Medicine, p. 617
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