Annals of Clinical Case Reports Case Report

Published: 30 Mar, 2020

Dextrocardia with Situs Inversus in an Adult Turkish

Seher Yılmaz1*, Ayse Kristina Polat2, Adem Tokpınar1 and Özlem Bozkurt3
1
Department of Anatomy, Yozgat Bozok University, Turkey
2
Yozgat Bozok University, Turkey

Abstract
Situs Inversus is a rare congenital anomaly caused by the displacement of the organs in the chest
and abdomen. Situs inversus totalis known as the displacement of all organs according to the mirror
image. Dextrocardia is used to describe the position of the heart which tip is pointing to the right
instead of left side of the chest.
People having situs inversus totalis and dextrocardia live with normal life expectancy and are
mostly asymptomatic. These anomalies may not be recognized for a long lifetime. Other congenital
disorders such as heart diseases and lung infections may progress with this condition. Although situs
inversus totalis with dextrocardia are rare, the lack of a comprehensive study of this anomaly in the
literature indicates that further research is needed. In our report, we describe a case of dextrocardia
with situs inversus totalis in a 21-year-old male.
Keywords: Situs inversus totalis, Dextrocardia; Rare anomaly

Introduction
Situs inversus totalis is a condition where the normal positions of the chest and abdominal organs
are arranged in a mirror image. Situs inversus totalis is known to be a rare syndrome inherited by
autosomal recessive genes. Situs inversus may be seen with levocardia or dextrocardia. In levocardia,
the tip of the heart is pointing to the left and in dextrocardia it turns to the right. Dextrocardia is
a developmental anomaly where a bulboventricular cycle is folded to the left of the primitive heart
cycle in a reverse placement of normal. The anomaly causes the heart to be positioned on the right
side of the chest along with the long right and downward orientation. The distribution of these
abnormalities was found to be equal between genders as well as between races [1]. Situs inversus
occurs in 1 in 4000 people in Japan, 1 in 5000 in Israel and 1 in 10,000 to 15,000 in Northern Europe
and the United States. Dextrocardia occurs in about 1 in 10,000 people in the general population.
OPEN ACCESS The exact cause of this condition, although it is unknown, has been associated with several factors
including incomplete penetration, maternal diabetes mellitus, and conjoined twin anomaly, as well
*Correspondence:
as autosomal recessive genes.
Seher Yilmaz, Department of Anatomy,
Yozgat Bozok University, Yozgat, People with situs inversus do not have a phenotypic difference and may maintain routine
Turkey, healthy life without any complication related to their medical condition. Most people with situs
E-mail: [email protected] inversus totalis are unconscious until they are treated for a medical condition independent of this
Received Date: 06 Mar 2020 anomaly [2,3].
Accepted Date: 26 Mar 2020 The diagnosis of dextrocardia is made by using a combination of clinical, radiological,
Published Date: 30 Mar 2020 electrocardiographic and echocardiographic findings. The anomaly is generally diagnosed on a
Citation: routine prenatal sonogram, but not every radiologist can identify it, especially if there are no cardiac
Yılmaz S, Kristina Polat A, Tokpınar structural abnormalities. Diagnostic methods such as chest radiography and electrocardiogram
A, Bozkurt Ö. Dextrocardia with Situs are sufficient to diagnose dextrocardia, but current methods for instance echocardiography and
Inversus in an Adult Turkish. Ann Clin magnetic resonance imaging are used for definitive diagnosis. Dextrocardia with situs inversus might
Case Rep. 2020; 5: 1814. be diagnosed incidentally during the evaluation of conditions not associated with the anomaly, in a
ISSN: 2474-1655 routine medical examination or as indicated in this case report [4-7].
Copyright © 2020 Seher Yılmaz. This The purpose of this study is to present a case with Dextrocardia and Situs Inversus in our country.
is an open access article distributed
under the Creative Commons Attribution
Case Presentation
License, which permits unrestricted A 21-year-old male patient was admitted to the urology outpatient clinic of Erciyes University
use, distribution, and reproduction in Hospital for urinary tract infection. His blood pressure was 130/80 mmHg and his pulse rate was
any medium, provided the original work 60 per min. No cardiovascular problems were observed. The patient stated that he had smoked 1
is properly cited. pack of cigarettes a day for 3 years. As a result of the ultrasonography, the organs of the patient

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Seher Yılmaz, et al., Annals of Clinical Case Reports - Radiology

Figure 1: Posteroanterior (PA) chest X-Ray image of the patient. Position of

the heart is changed according to the mirror image.

Figure 2: The ECG obtained from the patient revealed qRS positivity, which
were displaced symmetrically. The diagnosis was as situs inversus is the opposite of normal status in unipolar avR leads.
totalis, accompanied by dextrocardia by chest X-Ray (Figure 1) and
Electrocardiography (ECG) (Figure 2). radiography and computed tomography scans [17]. ECG is an essential
Discussion and interesting tool for diagnosis of dextrocardia. Echocardiography
is required for precise analysis of cardiac position as well as for the
Dextrocardia was first seen by Leonardo da Vinci in 1452 and recognition of associated congenital heart or vascular malformation.
later described by Marco Aurelio Severine in 1643 and more than Sonographic and computed tomography studies are needed to
a hundred years later was explained by Matthew Ballie [8]. "Situs" confirm the positions of abdominal organs anatomy [7]. Computed
term is used to define the position of internal organs. "Solitus" refers tomography and magnetic resonance imaging are known to be the
to the normal position and "Inversus" means the opposite position best method for demonstrating mirror anatomy of organs [18].
[9]. Dextrocardia with situs inversus is a rare condition occurring in
the general population is approximately one in every 10,000 people, Surgeons and radiologists have to avoid this abnormality before
but it is not yet known incidence in Turkey. There is no race-related or at the time of surgery, and should undergo a routine medical
difference for situs inversus and the male-female incidence is equal examination, that may indicate the presence of this condition. The
[10]. Situs inversus may be associated with other congenital problems medical examination will assist the patient when affected by clinical
such as asplenism, multiple spleens, duodenal atresia, horseshoe/ conditions such as appendicitis. If the pain is on the left side instead
ectopic kidney and various pulmonary/vascular abnormalities. Situs of the right side, it may lead to misdiagnosis and even death due to
Inversus Totalis was also associated with Kartagener's Syndrome, delay in surgical treatment [19].
a primary ciliary dyskinesia [11,12]. In our case, the cause of this Conclusion
anomaly was not found exactly. Follow-up of patients with situs
inversus totalis and dextrocardia is only necessary if there are Although situs inversus is a rare anomaly, studies dealing with
congenital heart defects or other associated syndromic features and this issue are limited. Increased awareness of this situation; surgeons
this condition is not noticed in patients with a healthy life expectancy and radiologists should be more careful to take the anomaly into
[13,14]. Recognition of situs inversus has a great importance for the consideration before and during surgery. It is also known that
prevention of surgical mishaps due to reversed anatomy or atypical encouraging patients to undergo a routine medical examination that
history. For example, appendicitis causes left lower quadrant pain may indicate the presence of this condition will improve life quality of
in a patient with situs inversus, while cholecystitis typically causes patients. In addition, sharing the experiences of rare patient type will
left upper quadrant pain. Cardiac situs is also determined by atrial provide guidance in future surgical procedures.
location. In situs inversus, the morphological right atrium is on the References
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