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.
Mirror-image dextrocardia is the most common form of cardiac malposition encountered and is almost always associated with situs inversus of the abdominal organs. The anatomic right ventricle is anterior to the left ventricle and the aortic arch curves to the right and posteriorly. The anatomic right lung with its three lobes is on the left side. Generally, there is no increased risk of an infracardiac malformation. Twenty-five percent of these patients will have associated sinusitis and bronchiactasis (Kartagener’s syndrome). The risk in these patients lies in the atypical presentation of diseases such as angina pectoris, myocardial infarction, acute cholecystitis, acute appendicitis, and diverticulitis where pain is referred to the “wrong” side. Recognizing the presence of dextrocardia will also help avoid unnecessary workup for abnormal ECG.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
- Copyright © 1995 by American Heart Association