NontradICUdoc

Why so Serious?????
15+ Year Member
Oct 16, 2003
2,425
256
44
Philadelphia Area
Status
Attending Physician
But the patient really have DextroCardia!! Her heart was on the right side of the chest, confirmed by CT!!!

Will probably never see it again.
 

J-Rad

Moderator Emeritus
15+ Year Member
Apr 12, 2003
3,542
21
With my Children Of The Corn
Status
Attending Physician
I hope the next question someone asked after suspecting dextrocardia was: which side are the guts on.

For curiosity's sake (if you're inclined): age range, why coming to the doctor (or ER), and why CT when there is a non-irradiating study that could have given the answer?
 
OP
NontradICUdoc

NontradICUdoc

Why so Serious?????
15+ Year Member
Oct 16, 2003
2,425
256
44
Philadelphia Area
Status
Attending Physician
I hope the next question someone asked after suspecting dextrocardia was: which side are the guts on.

For curiosity's sake (if you're inclined): age range, why coming to the doctor (or ER), and why CT when there is a non-irradiating study that could have given the answer?
The patient went to the ER for chest pain that would not subside. She knew she had the condition but she stunned the x-ray techs and the rest of the people at the ED with the film.

The chest pain was caused by hyperventilation due to an anxiety attack. So the dextracardia was not an incidental finding. Although, it was pretty wild listening to the heart sounds on the right side of the chest and setting up the leads on the right to look at the LV.
 

J-Rad

Moderator Emeritus
15+ Year Member
Apr 12, 2003
3,542
21
With my Children Of The Corn
Status
Attending Physician
Come on man, you're holding out ;) Where were the guts? Obviously you know a lot more about the case than me, but that question, depending on the rest of the history could be critical...Pleeeeaze:p
 

Jamers

Sexy Man
10+ Year Member
Dec 6, 2005
1,904
16
North Carolina
Status
Attending Physician
But the patient really have DextroCardia!! Her heart was on the right side of the chest, confirmed by CT!!!

Will probably never see it again.
haah I read this and I thought "he must be talking about the early episodes of Scrubs where the x-ray is backwards in the beginning of every episode" but its still cool none-the-less though.
 
OP
NontradICUdoc

NontradICUdoc

Why so Serious?????
15+ Year Member
Oct 16, 2003
2,425
256
44
Philadelphia Area
Status
Attending Physician
Come on man, you're holding out ;) Where were the guts? Obviously you know a lot more about the case than me, but that question, depending on the rest of the history could be critical...Pleeeeaze:p
I am in my fm rotation and the patient said she has situs inversus so I am assuming she is totally backwards. I only saw the cxr but it would have been cool to see the rest of her.
 

metalmd06

10+ Year Member
7+ Year Member
Nov 19, 2007
494
10
Status
Resident [Any Field]
Did the patient have Kartagener Syndrome?
 
OP
NontradICUdoc

NontradICUdoc

Why so Serious?????
15+ Year Member
Oct 16, 2003
2,425
256
44
Philadelphia Area
Status
Attending Physician
Where was the stomach bubble? That will tell you on both the CXR (most catch a little bit of the bubble) and likely the CT.
stupid me. I did not look. I was amazed at what I was seeing that I forgot to look for the gastric bubble.
 

J-Rad

Moderator Emeritus
15+ Year Member
Apr 12, 2003
3,542
21
With my Children Of The Corn
Status
Attending Physician
This is a very cool case given the CC. And to be given the Dx of hyperventilation as the underlying cause of the CC...requires a very detailed Hx. This is an extreme case of "diagnosis of exclusion".

Your homework assignment, if you choose to accept, is to figure out why this is so cool. (Hint: your google search should also include the words "situs solitus" and "inversus").

If the ED has a PACS system, can you snag an anonymized pic of the CXR? And how about an EKG?
 

J-Rad

Moderator Emeritus
15+ Year Member
Apr 12, 2003
3,542
21
With my Children Of The Corn
Status
Attending Physician
PS

A few life (in medicine) hints:

1. Don't always trust what the radiologist reports. They may not comment or even see if you didn't know to ask.
2. Never assume that a patient knows exactly what they have or what the significance of it is.
3. Never assume that a patient that might need to be followed for their whole lives for a particular condition actually is following up as recommended.

I'll get to why these points might be relevant later...
 

J-Rad

Moderator Emeritus
15+ Year Member
Apr 12, 2003
3,542
21
With my Children Of The Corn
Status
Attending Physician
Do a Pediatric Cardiac ICU rotation, you will see it atleast once a week
Indeed (and try echoing a dextrocardia, single something ventricle, Fontan...loads 'o fun:)). That's what interesting about the case as presented. Definitely not the expected milieu to just bump into it. So the DDx for her (presumably an adult) presenting complaint becomes interesting. If she has situs solitus there is a 90% chance she has congenital heart disease of some type. If she has situs inversus (without PCD [Kartagener's]) there is still a 10% chance of some type of CHD. Not all of these would be cyanotic or associated with pulmonary overcirculation (in this patient's case clearly not the former and likely not the latter) but some with some definite ties to the C/C if present in this patient.