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(Circulation. 1995;91:1602-1603.)
© 1995 American Heart Association, Inc.

Articles

Mirror-Image Dextrocardia With Situs Inversus

Ayman S. Al-Khadra, MD

From the Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Ayman S. Al-Khadra, MD, Four Longfellow Pl, Boston, MA 02114.

	Introduction

 
A 57-year-old white male was found to have an abnormal ECG (Fig 1) on admission for evaluation of rectal bleeding and anemia. The patient had no history of cardiac or sinopulmonary disease. Fig 1 shows the ECG with right-axis deviation of the P wave (negative in aVL and lead I and positive in aVR) and of the QRS complex indicating left to right activation, and low voltage in the left precordial leads. The chest x-ray (Fig 2) shows dextrocardia and right-sided gastric air bubble. A barium enema was performed to evaluate his rectal bleeding; that showed a right-sided sigmoid colon (Fig 3). Abdominal computed tomography (Fig 4) was done to look for metastasis from a possible cancer, and that demonstrates the left-sided liver and right-sided stomach, spleen, and descending aorta.

View larger version (110K): [in this window] [in a new window]   Figure 1. ECG showing marked right-axis deviation of the P wave (negative in aVL and lead I) and of the QRS complex, and low voltage in the precordial leads, V4 through V6. Lead aVR is similar to the normal aVL in the normal ECG.

View larger version (165K): [in this window] [in a new window]   Figure 2. Chest x-ray showing dextrocardia and right-sided gastric air bubble indicating the presence of both dextrocardia and situs inversus (the most common combination) and showing the reason behind missing this diagnosis on the "routine" chest film.

View larger version (110K): [in this window] [in a new window]   Figure 3. Barium enema showing right-sided sigmoid colon.

View larger version (132K): [in this window] [in a new window]   Figure 4. Abdominal computed tomography scan showing left-sided liver, gallbladder, and inferior vena cava and right-sided stomach, spleen, and abdominal aorta.

Mirror-image dextrocardia is the most . . . [Full Text of this Article]