eMedicine Specialties > Radiology > Pediatrics

Situs Inversus: Multimedia

Author: Annamaria Wilhelm, MD, Staff Physician, Department of Radiology, Mayo Clinic
Coauthor(s): John M Holbert, MD, Professor, Department of Radiology, Scott and White Memorial Hospital and Clinic
Contributor Information and Disclosures

Updated: Feb 24, 2009

Multimedia

Schematic drawings illustrate the standard anatom...
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Media file 1: Schematic drawings illustrate the standard anatomy of situs solitus (A) and the mirror image of situs inversus (B). The right lung (RL), left lung (LL), right atrium (RA), and left atrium (LA) are shown.
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Schematic drawings illustrate the standard anatom...

Schematic drawings illustrate the standard anatomy of situs solitus (A) and the mirror image of situs inversus (B). The right lung (RL), left lung (LL), right atrium (RA), and left atrium (LA) are shown.

Posteroanterior chest radiograph in a 40-year-old...
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Media file 2: Posteroanterior chest radiograph in a 40-year-old man with situs inversus and dextrocardia. This image shows that the cardiac apex (*) points to the right. A right-sided aortic arch (A) is associated with slight deviation of the trachea (T) to the left. The stomach (S) bubble is visible in the right upper quadrant.
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Posteroanterior chest radiograph in a 40-year-old...

Posteroanterior chest radiograph in a 40-year-old man with situs inversus and dextrocardia. This image shows that the cardiac apex (*) points to the right. A right-sided aortic arch (A) is associated with slight deviation of the trachea (T) to the left. The stomach (S) bubble is visible in the right upper quadrant.

Posteroanterior chest radiograph in a 55-year-old...
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Media file 3: Posteroanterior chest radiograph in a 55-year-old woman with Kartagener syndrome and situs inversus. This image shows a right-sided aortic arch (A) with slight leftward deviation of the trachea (T), dextrocardia (*), and a stomach bubble (S) in the right upper quadrant of the abdomen. Subtle bronchiectasis is also present in the lung bases (see Image 4 in Multimedia).
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Posteroanterior chest radiograph in a 55-year-old...

Posteroanterior chest radiograph in a 55-year-old woman with Kartagener syndrome and situs inversus. This image shows a right-sided aortic arch (A) with slight leftward deviation of the trachea (T), dextrocardia (*), and a stomach bubble (S) in the right upper quadrant of the abdomen. Subtle bronchiectasis is also present in the lung bases (see Image 4 in Multimedia).

Magnified view of the left lower lobe in a 55-yea...
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Media file 4: Magnified view of the left lower lobe in a 55-year-old woman with Kartagener syndrome and situs inversus (same patient as in Image 3 in Multimedia). This image shows bronchiectasis (arrows).
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Magnified view of the left lower lobe in a 55-yea...

Magnified view of the left lower lobe in a 55-year-old woman with Kartagener syndrome and situs inversus (same patient as in Image 3 in Multimedia). This image shows bronchiectasis (arrows).

Radiograph of the upper abdomen from a barium ene...
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Media file 5: Radiograph of the upper abdomen from a barium enema examination in a 40-year-old man with situs inversus and dextrocardia. This image shows the liver (L) in the left upper quadrant of the abdomen. The positions of the splenic flexure (SF) and hepatic flexure (HF) are reversed. (See also Images 6-9 in Multimedia.)
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Radiograph of the upper abdomen from a barium ene...

Radiograph of the upper abdomen from a barium enema examination in a 40-year-old man with situs inversus and dextrocardia. This image shows the liver (L) in the left upper quadrant of the abdomen. The positions of the splenic flexure (SF) and hepatic flexure (HF) are reversed. (See also Images 6-9 in Multimedia.)

Radiograph of the lower abdomen from a barium ene...
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Media file 6: Radiograph of the lower abdomen from a barium enema examination in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5 and 7-9 in Multimedia). This image shows the sigmoid colon (SC) on the right and the cecum (C) on the left.
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Radiograph of the lower abdomen from a barium ene...

Radiograph of the lower abdomen from a barium enema examination in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5 and 7-9 in Multimedia). This image shows the sigmoid colon (SC) on the right and the cecum (C) on the left.

Chest computed tomography scan obtained at the le...
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Media file 7: Chest computed tomography scan obtained at the level of the origins of the great vessels in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5-6 and 8-9 in Multimedia). This image demonstrates mirror-image branching of the great vessels (*) and a left-sided superior vena cava (+).
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Chest computed tomography scan obtained at the le...

Chest computed tomography scan obtained at the level of the origins of the great vessels in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5-6 and 8-9 in Multimedia). This image demonstrates mirror-image branching of the great vessels (*) and a left-sided superior vena cava (+).

Chest computed tomography scan obtained at the le...
(Enlarge Image)
Media file 8: Chest computed tomography scan obtained at the level of the aortic outflow tract in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5-7 and 9 in Multimedia.) This image shows reversal of the normal cardiac anatomy. The left atrium (LA), right atrium (RA), left ventricle (LV), and right ventricle (RV) are shown. The descending aorta (DA) is on the right.
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Chest computed tomography scan obtained at the le...

Chest computed tomography scan obtained at the level of the aortic outflow tract in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5-7 and 9 in Multimedia.) This image shows reversal of the normal cardiac anatomy. The left atrium (LA), right atrium (RA), left ventricle (LV), and right ventricle (RV) are shown. The descending aorta (DA) is on the right.

Computed tomography scan of the upper abdomen in ...
(Enlarge Image)
Media file 9: Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5-8 in Multimedia). This image shows reversal of the normal anatomy. The spleen (SP), stomach (ST), and liver (L) are shown. The descending aorta (DA) is on the right.
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Computed tomography scan of the upper abdomen in ...

Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia (same patient as in Images 5-8 in Multimedia). This image shows reversal of the normal anatomy. The spleen (SP), stomach (ST), and liver (L) are shown. The descending aorta (DA) is on the right.

More on Situs Inversus

Overview: Situs Inversus
Imaging: Situs Inversus
Follow-up: Situs Inversus
Multimedia: Situs Inversus
References
Further Reading
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References

  1. Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease. 4th ed. Philadelphia, Pa: WB Saunders Co; 1989:777.

  2. Fraser RS, Muller NL, Colman NC, Pare PD. Fraser and Pare's Diagnosis of Diseases of the Chest. Vol 3. 4th ed. Philadelphia, Pa: WB Saunders Co; 1999:2281-3.

  3. Gutgesell HP. Cardiac malposition and heterotaxy. In: Garson AG Jr, Fisher DJ, Neish SR, eds. Science and Practice of Pediatric Cardiology. Vol 2. 2nd ed. Baltimore, Md: Williams & Wilkins; 1998:1539-61.

  4. Hagler DJ, O'Leary PW. Cardiac malpositions and abnormalities of atrial and visceral situs. In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgesell HP, eds. Moss and Adams' Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult. Vol 2. 5th ed. Baltimore, Md: Williams & Wilkins; 1995:1307-36.

  5. Higgins CB. Essentials of Cardiac Radiology and Imaging. Philadelphia, Pa: JB Lippincott Co; 1992:283-331.

  6. Jefferson K, Rees S. Clinical Cardiac Radiology. 2nd ed. London, UK: Butterworths; 1980:9-67.

  7. Perloff JK. Clinical Recognition of Congenital Heart Disease. 4th ed. Philadelphia, Pa: WB Saunders Co; 1994.

  8. Winer-Muram HT. Adult presentation of heterotaxic syndromes and related complexes. J Thorac Imaging. 1995;10(1):43-57. [Medline].

  9. Lee SE, Kim HY, Jung SE, et al. Situs anomalies and gastrointestinal abnormalities. J Pediatr Surg. Jul 2006;41(7):1237-42. [Medline].

  10. Ortega HA, Vega Nde A, Santos BQ, Maia GT. [Primary ciliary dyskinesia: considerations regarding six cases of Kartagener syndrome.] [Portuguese, English]. J Bras Pneumol. Oct 2007;33(5):602-8. [Medline]. [Full Text].

  11. Holzmann D, Ott PM, Felix H. Diagnostic approach to primary ciliary dyskinesia: a review. Eur J Pediatr. Jan-Feb 2000;159(1-2):95-8. [Medline].

  12. Kinney TB, DeLuca SA. Kartagener's syndrome. Am Fam Physician. Jul 1991;44(1):133-4. [Medline].

  13. Schidlow DV. Primary ciliary dyskinesia (the immotile cilia syndrome). Ann Allergy. Dec 1994;73(6):457-68; quiz 468-70. [Medline].

  14. Yarnal JR, Golish JA, Ahmad M, Tomashefski JF. The immotile cilia syndrome: explanation for many a clinical mystery. Postgrad Med. Feb 1982;71(2):195-7, 200-2, 209-11 passim. [Medline].

  15. Jain K, Padley SP, Goldstraw EJ, et al. Primary ciliary dyskinesia in the paediatric population: range and severity of radiological findings in a cohort of patients receiving tertiary care. Clin Radiol. Oct 2007;62(10):986-93. [Medline].

  16. Kennedy MP, Omran H, Leigh MW, et al. Congenital heart disease and other heterotaxic defects in a large cohort of patients with primary ciliary dyskinesia. Circulation. Jun 5 2007;115(22):2814-21. [Medline].

  17. Bohun CM, Potts JE, Casey BM, Sandor GG. A population-based study of cardiac malformations and outcomes associated with dextrocardia. Am J Cardiol. Jul 15 2007;100(2):305-9. [Medline].

  18. Maldjian PD, Saric M. Approach to dextrocardia in adults: review. AJR Am J Roentgenol. Jun 2007;188(6 suppl):S39-49; quiz S35-8. [Medline].

  19. Gindes L, Hegesh J, Barkai G, Jacobson JM, Achiron R. Isolated levocardia: prenatal diagnosis, clinical importance, and literature review. J Ultrasound Med. Mar 2007;26(3):361-5. [Medline].

  20. Fung TY, Chan DL, Leung TN, Leung TY, Lau TK. Dextrocardia in pregnancy: 20 years' experience. J Reprod Med. Jul 2006;51(7):573-7. [Medline].

  21. Douglas YL, Jongbloed MR, den Hartog WC, Bartelings MM, Bogers AJ, Ebels T, et al. Pulmonary vein and atrial wall pathology in human total anomalous pulmonary venous connection. Int J Cardiol. Dec 29 2008;[Medline].

  22. Xu BP, Shen KL, Hu YH, Feng XL, Li HM, Lang ZQ. [Clinical characteristics of primary ciliary dyskinesia in children]. Zhonghua Er Ke Za Zhi. Aug 2008;46(8):618-22. [Medline].

  23. Schrott-Fischer A, Rieger G, Morass B, Bitsche M, Horak E, Riechelmann H, et al. [Diagnostics of primary ciliary dyskinesia]. Laryngorhinootologie. Nov 2008;87(11):809-20; quiz 821-5. [Medline].

  24. Van Mierop LH, Eisen S, Schiebler GL. The radiographic appearance of the tracheobronchial tree as an indicator of visceral situs. Am J Cardiol. Oct 1970;26(4):432-5. [Medline].

  25. Palumbo E. [Neonatal diagnosis of primary ciliary dyskinesia. Recent advances]. Recenti Prog Med. Apr 2008;99(4):207-9. [Medline].

  26. Applegate KE, Goske MJ, Pierce G, Murphy D. Situs revisited: imaging of the heterotaxy syndrome. Radiographics. Jul-Aug 1999;19(4):837-52; discussion 853-4. [Medline]. [Full Text].

  27. Silverman NH. An ultrasonic approach to the diagnosis of cardiac situs, connections, and malpositions. Cardiol Clin. Aug 1983;1(3):473-86. [Medline].

  28. Tonkin IL, Tonkin AK. Visceroatrial situs abnormalities: sonographic and computed tomographic appearance. AJR Am J Roentgenol. Mar 1982;138(3):509-15. [Medline]. [Full Text].

  29. Partridge J. The radiological evaluation of atrial situs. Clin Radiol. Jan 1979;30(1):95-103. [Medline].

  30. Bartram U, Fischer G, Kramer HH. Congenitally interrupted inferior vena cava without other features of the heterotaxy syndrome: report of 5 cases and characterization of a rare entity. Pediatr Dev Pathol. Mar 22 2007;1 [epub ahead of print]. [Medline].

  31. Yoo SJ, Kim YM, Choe YH. Magnetic resonance imaging of complex congenital heart disease. Int J Card Imaging. Apr 1999;15(2):151-60. [Medline].

  32. Kouwenhoven JW, Bartels LW, Vincken KL, et al. The relation between organ anatomy and pre-existent vertebral rotation in the normal spine: magnetic resonance imaging study in humans with situs inversus totalis. Spine. May 1 2007;32(10):1123-8. [Medline].

  33. Sirin BH, Kurdal AT, Iskesen I. Congenitally corrected transposition of the great arteries plus dextrocardia operated with an unusual operative technique. Thorac Cardiovasc Surg. Sep 2008;56(6):367-9. [Medline].

  34. Rossman CM, Newhouse MT. Primary ciliary dyskinesia: evaluation and management. Pediatr Pulmonol. 1988;5(1):36-50. [Medline].

  35. Tan SY, Rosenthal J, Zhao XQ, et al. Heterotaxy and complex structural heart defects in a mutant mouse model of primary ciliary dyskinesia. J Clin Invest. Nov 21 2007;epub ahead of print. [Medline]. [Full Text].

  36. Winer-Muram HT, Tonkin IL. The spectrum of heterotaxic syndromes. Radiol Clin North Am. Nov 1989;27(6):1147-70. [Medline].

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Keywords

situs inversus, situs inversus totalis, situs inversus with dextrocardia, situs inversus with levocardia, mirror image of situs solitus, mirror-image organs, situs solitus, situs ambiguous/ambiguus, Kartagener syndrome, Kartagener's syndrome, primary ciliary dysplasia, PCD, primary ciliary diskinesia

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Contributor Information and Disclosures

Author

Annamaria Wilhelm, MD, Staff Physician, Department of Radiology, Mayo Clinic
Annamaria Wilhelm, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

John M Holbert, MD, Professor, Department of Radiology, Scott and White Memorial Hospital and Clinic
John M Holbert, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Amirsys Royalty Other

Medical Editor

Henrique M Lederman, MD, PhD, Consulting Staff, Department of Radiology, LeBonheur Children's Medical Center and St Jude Children's Research Hospital; Professor of Radiology and Pediatric Radiology, Chief, Division of Diagnostic Imaging in Pediatrics, Federal University of Sao Paulo, Brazil
Henrique M Lederman, MD, PhD is a member of the following medical societies: Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Marta Hernanz-Schulman, MD, FAAP, Professor, Radiology, Radiological Sciences, and Pediatrics, Director, Department of Pediatric Radiology, Radiologist-in-Chief, Director, Department of Diagnostic Imaging, Vanderbilt University Medical Center, Vanderbilt Children's Hospital
Marta Hernanz-Schulman, MD, FAAP is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Roentgen Ray Society
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Consulting Staff, Department of Radiology, King's College Hospital, London
Disclosure: Nothing to disclose.

 
 
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