Case Author(s): Thomas H. Vreeland, M.D. , 08/27/94 . Rating: #D3, #Q3

Diagnosis: Situs Inversus

Brief history:

Preoperative lung transplant evaluation

Images:

Cardiac Blood Pool Imaging

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Full history/Diagnosis is available below

Diagnosis: Situs Inversus

Full history:

This patient is 25-year-old man with a history of Kartagener's Syndrome, who is being evaluated for possible lung transplantation. This test was ordered to assess the baseline cardiac function.

Findings:

This study demonstrates situs inversus or the "mirror image" of the normal heart. Also, the lung fields are oligemic.

Discussion:

Situs - refers to the position of the left atrium and stomach. The bronchial anatomy generally follows the atria, which in turn, generally follows the stomach (except in azygos continuation of the inferior vena cava).

Situs solitus: Normal heart, with the left atrium, left, systemic ventricle, aorta, and stomach are on the same side.

Situs inversus: "Mirror image" of situs solitus with the left atrium and stomach are on the right.

Situs Ambiguous: the position of the left atrium and stomach is uncertain.

Cardia: refers to the side of the left ventricular apex

Levocardia: normal, with the LV apex on the left

Dextrocardia: the LV apex is intrinsically on the right because of malposition.

"Mirror Image" is associated with very high incidence of congenital heart disease, especially Tetralogy of Fallot.

Kartagener's Syndrome:

AKA Immotile Cilia Syndrome or Dysmotile Cilia Syndrome

Incidence: familial, with 1:40,000

Etiology: Deficiency of the dynein arms of the cilia resulting in abnormal mucociliary function of the respiratory and auditory epithelium as well as sperm.

TRIAD: Situs inversus, bronchiectasis, & sinusitis

ACR Codes and Keywords:

References and General Discussion of Cardiac Blood Pool Scintigraphy (Anatomic field:Heart and Great Vessels, Category:Normal, Technique, Congenital Anomaly)

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Case number: ca001

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