Incidental Finding of Dextrocardia with Situs Inversus in a 59-Year-Old Man

Abstract

Dextrocardia with situs inversus is a rare congenital anomaly, which is characterized by right-sided heart apex and inversely rotated visceral organs of the abdomen. We report an unusual case of dextrocardia with situs inversus in a 59-year-old man, referred for a pelvic ultrasound scan because of symptoms of lower urinary tract obstruction and after a fairly normal prostate specific antigen (PSA) value. A diagnosis of enlarged prostate gland with a prominent median lobe and significant residual urine volume was made, which necessitated the examination of the kidneys for hydronephrosis, resulting in the incidental finding of situs inversus. On further investigation, the diagnosis of dextrocardia with situs inversus was made. Physicians should look out for this anomaly primarily because it may be associated with other conditions like primary ciliary dyskinesia so appropriate interventions are offered to reduce morbidities and mortality.

Figure 1

Ultrasound image of the epigastric region in longitudinal plane. This shows a left-sided liver and gallbladder instead of its normal right-sided anatomical position.

Figure 2

Sonogram of the right hypochondrium in longitudinal plane. The spleen is in the right upper quadrant under the right hemidiaphragm adjacent to the right kidney.

Figure 3

Colour Doppler ultrasound image of the epigastrium in transverse plane. This demonstrates a right-sided abdominal aorta (AO) and left sided inferior vena cava (IVC). Also showing a right-sided stomach and a left-sided liver, which is the reverse of their normal anatomical positions.

Figure 4

Transverse sonogram without Colour Doppler of the epigastrium. The head of the pancreas on the left side and a gas filled stomach on the right side. Abdominal aorta (AO) on the right side and inferior vena cava (IVC) on the left.

Figure 5

Frontal chest radiograph. It shows the apex of the heart pointing to the right, ascending and arch of the aorta on the right, gastric air bubble and splenic flexure both on the right side under the diaphragm opposite of the normal anatomical findings.

Figure 6

Barium sulphate meal spot radiograph. This shows the stomach on the right under the right hemidiaphragm, a definite air-barium level under the right hemidiaphragm with the heavier barium inferiorly and gastric air superiorly.