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Ladak R, Magnuson W. Polysplenia with situs inversus totalis, azygos continuation of the inferior vena cava, and duplication of the superior vena cava in a healthy adult: A case report. Radiol Case Rep 2024; 19:4184-4189. [PMID: 39101022 PMCID: PMC11295447 DOI: 10.1016/j.radcr.2024.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/16/2024] [Accepted: 06/27/2024] [Indexed: 08/06/2024] Open
Abstract
Polysplenia syndrome is an embryological disorder whereby the usual left-right asymmetry of thoracic and abdominal viscera fails to develop. It is a rare entity, estimated to occur at a frequency of 1 in 40,000, and is often associated with cardiac and biliary abnormalities. More than 75% of patients die before the age of 5 years, and even in the absence of cardiac anomalies, only 5%-10% of patients are expected to survive into adulthood without complications. Although polysplenia syndrome encompasses a wide range of anatomic abnormalities, there is no single pathognomonic feature. Hence, the prognosis of patients with polysplenia depends on their anatomy, thus necessitating radiology in their management. Here we present a case of a 56-year-old man with polysplenia syndrome and situs inversus totalis. This presentation is atypical because polysplenia is usually considered a form of situs ambiguus, and cases with situs inversus totalis are exceedingly rare. Also noted in our patient are variations in the great vessels, including aortic arch branches and the venae cavae which are features not typically associated with either polysplenia syndrome or situs inversus totalis. The patient is healthy and asymptomatic at baseline, with his diagnosis being made incidentally. Our case report is the first to describe this unique combination of cardiothoracic and cardiovascular anatomy. It also emphasizes the importance of radiologists in caring for patients with laterality defects. As these disorders are uncommon, more data on their anatomic variations may help provide better medical care to this patient population.
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Affiliation(s)
- Rahman Ladak
- Department of Undergraduate Medical Education, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - William Magnuson
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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2
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Morimoto T, Yoshimoto N, Kuragaichi T, Taki J, Yamada K. Mechanical thrombectomy for cerebrovascular occlusion in a patient with situs inversus. Radiol Case Rep 2024; 19:3488-3491. [PMID: 38872738 PMCID: PMC11170093 DOI: 10.1016/j.radcr.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
Situs inversus is a rare congenital abnormality characterized by mirror-image transposition of the major visceral organs and vessels. Few reports have discussed the use of mechanical thrombectomy in acute ischemic stroke with situs inversus. We present such a case, to raise awareness and deepen the knowledge on these cases. A 44-year-old man was admitted to our hospital with sudden-onset dysarthria and left-sided paresis. Computed tomography (CT) angiography revealed situs inversus and occlusion in the internal carotid artery. First, intravenous tissue plasminogen activator was administered, followed by immediate reperfusion with mechanical thrombectomy. We achieved thrombolysis in cerebral infarction grade 3. After the procedure, the patient fully recovered. Prompt diagnosis is crucial for rapid recanalization in patients with vascular anomalies such as situs inversus.
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Affiliation(s)
- Takaaki Morimoto
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Takashi Kuragaichi
- Department of Cardiology, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Junya Taki
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Keisuke Yamada
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
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3
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Qian W, Curtain BMM, Ryan JP, Navadgi S. Locally invasive cholangiocarcinoma causing gastric outlet obstruction in heterotaxy syndrome: A case report and review of literature. Radiol Case Rep 2024; 19:531-534. [PMID: 38044905 PMCID: PMC10686879 DOI: 10.1016/j.radcr.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 12/05/2023] Open
Abstract
Heterotaxy syndrome is a disease of embryo development resulting in abnormal distribution of thoracic and abdominal organs across the left-right axis. In this case, A 77-year-old gentleman was admitted with gastric outlet obstruction secondary to cholangiocarcinoma. This is on a background of heterotaxy syndrome, specifically situs ambiguus. The patient's anatomical variations included a right-sided stomach, midline liver, and asplenia. Due to variant anatomy and risk of aspiration; endoscopy was abandoned in favor of surgical bypass via a gastrojejunostomy. Although technically challenging, complex upper abdominal surgery in heterotaxy syndrome has been described in the literature. Variations in anatomy observed in heterotaxy syndrome may render patients ineligible for resection of cholangiocarcinoma and increase the risk of complications. Careful preoperative planning with imaging and meticulous intraoperative dissection is required.
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Affiliation(s)
- Wanyang Qian
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia
| | | | - James P. Ryan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Suresh Navadgi
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia
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Kim HN, Lee Y, Hong SJ, Kang JH, Jung JH. CT Findings of Azygos Venous System: Congenital Variants and Acquired Structural Changes. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:95-108. [PMID: 38362401 PMCID: PMC10864146 DOI: 10.3348/jksr.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 02/17/2024]
Abstract
The azygos venous system is a crucial conduit of the posterior thorax and potentially vital collateral pathway. However, it is often overlooked clinically and radiologically. This pictorial essay reviews the normal azygos venous anatomy and CT findings of congenital variations and structural changes associated with acquired pathologies.
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Hayashi LC, Acharya R. Situs inversus totalis in an asymptomatic adolescent - importance of patient education: A case report. World J Clin Pediatr 2023; 12:359-364. [PMID: 38178936 PMCID: PMC10762603 DOI: 10.5409/wjcp.v12.i5.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Situs inversus totalis (SIT) may be an incidental finding in asymptomatic children. Patients may not understand the implications of this condition and the importance of relaying the diagnosis to their healthcare providers. CASE SUMMARY We report an asymptomatic seventeen-year-old adolescent with previously-diagnosed SIT who presented for a routine well-child visit. During history taking, he denied any past medical conditions, including cardiovascular conditions. Only when physical exam revealed point of maximal impulse and heart sounds on the right side, did he convey that he had been diagnosed with SIT incidentally at age of 12 years. He was not aware of associated conditions or the potential implications of his diagnosis, nor did he realize it is pertinent medical history to be relayed to healthcare providers. Chest X-ray confirmed dextrocardia and abdominal X-ray showed right-sided stomach. Abdomen sonogram showed left-sided liver and right-sided spleen. Echocardiogram showed normal valvular structure and function. A comprehensive discussion was provided to address the patient's lack of understanding that SIT is a medical diagnosis with potential implications. CONCLUSION While SIT is rare and mostly asymptomatic, affected patients may not comprehend the importance of the diagnosis and its potential ramifications. Recognition of the patient's lack of awareness allows the healthcare provider to educate the patient and hopefully can prevent potential medical and surgical complications.
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Affiliation(s)
- Lauren C. Hayashi
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32608, United States
| | - Ratna Acharya
- Division of General Pediatrics, Department of Pediatrics, University of Florida, Gainesville, FL 32608, United States
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Li N, Wang HX, Sun YH, Shu Y. Successful leadless pacemaker implantation in a patient with dextroversion of the heart: A case report. World J Clin Cases 2023; 11:8089-8093. [DOI: 10.12998/wjcc.v11.i33.8089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/22/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Dextroversion is defined as the presence of dextrocardia with situs solitus, dextro-loop ventricles, and normally related great arteries. Dextrocardia can pose technical challenges when interventional treatments are required. However, the challenges posed by dextroversion can be amplified due to the disruption of typical anatomical relationships, the unpredictable positioning and boundaries of cardiac structures resulting from the shift, and the pathological processes influencing rotation.
CASE SUMMARY A 73-year-old woman with cardiac dextroversion suffered from a recurrence of atrial fibrillation after her radiofrequency catheter ablation and Despite the cessation of antiarrhythmic medications, there were episodes of sinus pauses and symptomatic bradycardia, with heart rates dropping as low as 28 beats per minute.
CONCLUSION Dextroversion makes the implantation of leadless pacemakers more challenging, and appropriate adjustments in fluoroscope angles may be crucial for intracardiac operations. Additionally, when advancing delivery systems, attention should be paid to rotational direction during valve-crossing procedures; changes in the perspective of posture angle between normal cardiac position and dextroversion can serve as references.
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Affiliation(s)
- Na Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Hai-Xiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Yue-Hui Sun
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Yan Shu
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
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Chaudhary RK, Nepal P, Kumar S, Gupta E, Sangroula N, Nagar A, Ojili V. Imaging of inferior vena cava normal variants, anomalies and pathologies, Part 1: Congenital. SA J Radiol 2023; 27:2687. [PMID: 38226291 PMCID: PMC10788309 DOI: 10.4102/sajr.v27i1.2687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/14/2023] [Indexed: 01/17/2024] Open
Abstract
The embryology of the inferior vena cava (IVC) is complex, involving the sequential appearance and regression of multiple segments that ultimately form the IVC. Any alteration in this process during embryogenesis can result in congenital anomalies of the IVC. This study aimed to recognise common as well as rare anomalies of the IVC and associated veins, and their clinical implications. The anomalies tend to have diverse appearances based on the timing and segments involved. The development of the IVC is intertwined with the development of other veins like the renal vein, azygos vein and portal vein, and these veins may also be anomalous. Additionally, IVC anomalies are associated with various other congenital anomalies including cardiac anomalies, the recognition of which may be important for patient care. The IVC tends to have multiple normal variants and anomalies because of a complex process involving multiple segments contributing to the adult IVC. Knowledge of these variants is crucial for preoperative planning of procedures. Contribution This study would help in understanding the embryogenesis of the IVC and correlation with the imaging appearances and the clinical implications of each of these common as well as rare types of congenital anomalies.
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Affiliation(s)
- Ranjit K. Chaudhary
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, United States of America
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Boston, United States of America
| | - Shruti Kumar
- Department of Radiology, University of Arkansas, Little Rock, United States of America
| | - Elina Gupta
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, United States of America
| | - Nikita Sangroula
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, United States of America
| | - Arpit Nagar
- Department of Radiology, Ohio State University Wexner Medical Center, Ohio, United States of America
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, United States of America
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8
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Kızıloğlu HA. A Rare Combination: Left Isomerism and Calcific Fibrous Tumor of the Pleura. Arch Bronconeumol 2023:S0300-2896(23)00104-7. [PMID: 37005149 DOI: 10.1016/j.arbres.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
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Bae K, Jeon KN. Left Bronchial Isomerism with Right-Sided Tracheal Bronchus: A Rare Case Report. Diagnostics (Basel) 2023; 13:diagnostics13040751. [PMID: 36832240 PMCID: PMC9956013 DOI: 10.3390/diagnostics13040751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
The tracheal bronchus is a congenital bronchial branching anomaly defined as an aberrant bronchus arising in either the trachea or a main bronchus. Left bronchial isomerism is characterized by two bilobed lungs, bilateral long main bronchi, and both pulmonary arteries passing superiorly to their respective upper lobe bronchi. Left bronchial isomerism with a right-sided tracheal bronchus is a very rare combination of tracheobronchial anomalies. It has not been previously reported. We present multi-detector CT findings of a left bronchial isomerism with a right-sided tracheal bronchus of a 74 year old man.
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Affiliation(s)
- Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
- Correspondence: ; Tel.: +82-55-214-3896
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10
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Plumptre H, Giannoudi M, Kurian J. An usual case of bilateral deep venous thrombosis with associated pulmonary embolus. Oxf Med Case Reports 2022; 2022:omac115. [DOI: 10.1093/omcr/omac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/08/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT
Congenital absence of the inferior vena cava (IVC) triggers collateral vessel growth to drain the peripheries and abdominal organs. This causes venous stasis and increases the risk of deep vein thrombosis (DVT) and pulmonary embolism. Typically, patients with absent IVCs present before 30 years of age, with bilateral DVT symptoms triggered by intense exercise. The abnormality can remain undetected as computed tomography imaging is not usually performed. Due to the increased risk of clotting, these patients should be on life-long anticoagulation. Raising clinical awareness of this condition, to ensure appropriate investigations and treatment, is important.
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11
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Elkoussy AMM, Taha AMI, Hassan RA, Nazeh KW. Pancreaticoduodenectomy for pancreatic adenocarcinoma in a patient with situs inversus abdomenalis, a case report. Int J Surg Case Rep 2022; 95:107220. [PMID: 35617735 PMCID: PMC9133586 DOI: 10.1016/j.ijscr.2022.107220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ahmed M M Elkoussy
- HPB Surgery and Liver Transplantation Unit, Surgery Department, Al-Rajhi University Liver Hospital, Assiut University, Egypt.
| | - Ahmed M I Taha
- HPB Surgery and Liver Transplantation Unit, Surgery Department, Al-Rajhi University Liver Hospital, Assiut University, Egypt.
| | - Ramy A Hassan
- HPB Surgery and Liver Transplantation Unit, Surgery Department, Al-Rajhi University Liver Hospital, Assiut University, Egypt.
| | - Kirollos W Nazeh
- Radiology Department, Assiut University Hospital, Assiut University, Egypt
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12
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Eitler K, Bibok A, Telkes G. Situs Inversus Totalis: A Clinical Review. Int J Gen Med 2022; 15:2437-2449. [PMID: 35264880 PMCID: PMC8901252 DOI: 10.2147/ijgm.s295444] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Katalin Eitler
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - András Bibok
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Gábor Telkes
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
- Correspondence: Gábor Telkes, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, VIII. Baross u.23., Budapest, H-1082, Hungary, Tel +36 20 825 8593, Email
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13
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Clinical implications of congenital interruption of inferior vena cava. J Formos Med Assoc 2022; 121:1938-1944. [DOI: 10.1016/j.jfma.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
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14
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Lahel R. Heterotaxy: Rare case of isolated duodenojejunal junction malposition. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Ghosh S, Fox S, Mehta AC. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac107. [PMID: 35474952 PMCID: PMC9035323 DOI: 10.1093/jscr/rjac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
A 36-year-old female with a past medical history of primary ciliary dyskinesia and bilateral lung transplantation was noted to have a rare and confounding postsurgical anatomy acquired as a result of transplantation. Bronchoscopy and computed tomography showed isomeric main bronchi with a tri-lobed right lung, a bi-lobed left lung and dextrocardia. This rare phenomenon can be observed in lung transplant recipients with situs ambiguous morphology of their native lungs, who receive donor lungs with normal situs solitus morphology. To the best of our knowledge, ours is the first reported case of such a composite bronchopulmonary situs abnormality. Careful review of bronchial anatomy should be done with the help of CT imaging prior to undertaking any bronchial interventions in these subset of patients with bronchial isomerism and bilateral lung transplantation.
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Affiliation(s)
- Subha Ghosh
- Correspondence address. Thoracic Imaging, Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA. Tel: (216)-213-9864; E-mail:
| | - Steven Fox
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, OH, USA
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Srikant S, Dave D, Dave D. Isolated Dextrocardia with Situs Solitus - Dextroversion in a Ugandan Baby: A Case Report. Int Med Case Rep J 2021; 14:797-800. [PMID: 34866941 PMCID: PMC8636690 DOI: 10.2147/imcrj.s340185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Dextrocardia is a rare congenital abnormality in the general population, with an estimated incidence of 1 in 12,000 live births. Isolated dextrocardia, the condition of right-sided heart with situs solitus is most commonly referred to as dextroversion. Case Presentation A 2-month-old Ugandan baby boy discovered to have isolated dextrocardia with situs solitus presented with fever, cough, and difficulty in breathing. Physical examination revealed moderate respiratory distress, bilateral basal fine crepitations, tachycardia with regular pulse, and heart sounds best heard on the right hemithorax, but no murmurs. Chest X-ray confirmed right-sided cardiac shadow with cardiac apex pointing to right. Echocardiography showed D-loop ventricular morphology with right cardiac axis and ventricular apex to right, plus tiny patent ductus arteriosus. Abdominal ultrasound showed normal situs solitus; however, the left kidney was noted in pelvic space. Conclusion Isolated dextrocardia with situs solitus (dextroversion) is a rare scenario. This case exhibits a learning point in the significance of routine medical examination of patients to identify anomalies and upon suspicion a thorough evaluation to prevent wrong diagnosis or poor prognosis due to delayed management.
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Affiliation(s)
- Sanjanaa Srikant
- Department of Medicine, Makerere University College of Health Sciences, Kampala City, Uganda
| | - Darshit Dave
- Department of Paediatrics, Uganda Martyrs Hospital Lubaga, Kampala City, Uganda
| | - Dhara Dave
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Seidl‐Mlczoch E, Kasprian G, Ba‐ssalamah A, Stuempflen M, Kitzmueller E, Muin DA, Zimpfer D, Prayer D, Michel‐behnke I, Ulm B. Characterization of phenotypic spectrum of fetal heterotaxy syndrome by combining ultrasound and magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:837-845. [PMID: 34097330 PMCID: PMC9299896 DOI: 10.1002/uog.23705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Heterotaxy or isomerism of the atrial appendages is a congenital disorder with variable presentation, associated with both cardiac and non-cardiac anomalies, which may have a serious impact on fetal outcome. The aim of this exploratory study was to assess the value of fetal magnetic resonance imaging (MRI), as a complementary tool to ultrasound, for describing the morphological spectrum encountered in heterotaxy. METHODS This retrospective study included 27 fetuses that underwent fetal MRI following prenatal suspicion of heterotaxy on ultrasound from 1998 to 2019 in a tertiary referral center. Heterotaxy was classified as left atrial isomerism (LAI) or right atrial isomerism (RAI) based on fetal echocardiography (FE) examination. In addition to routine prenatal ultrasound, fetal MRI was offered routinely to enhance the diagnosis of non-cardiac anomalies, which might have been missed on ultrasound. Prenatal findings on ultrasound, FE and MRI were reviewed systematically and compared with those of postnatal imaging and autopsy reports. RESULTS Twenty-seven fetuses with heterotaxy and cardiovascular pathology, of which 19 (70%) had LAI and eight (30%) had RAI, were included. Seven (7/19 (37%)) fetuses with LAI had normal intracardiac anatomy, whereas all fetuses with RAI had a cardiac malformation. All 27 fetuses had non-cardiac anomalies on fetal MRI, including situs and splenic anomalies. In 12/19 (63%) fetuses with LAI, a specific abnormal configuration of the liver was observed on MRI. In three fetuses, fetal MRI revealed signs of total anomalous pulmonary venous connection obstruction. An abnormal bronchial tree pattern was suspected on prenatal MRI in 6/19 (32%) fetuses with LAI and 3/8 (38%) fetuses with RAI. CONCLUSIONS Visualization on MRI of non-cardiac anomalies in fetuses with suspected heterotaxy is feasible and can assist the complex diagnosis of this condition, despite its limitations. This modality potentially enables differentiation of less severe cases from more complex ones, which may have a poorer prognosis. Fetal MRI can assist in prenatal counseling and planning postnatal management. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. Seidl‐Mlczoch
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division of Pediatric CardiologyMedical University of ViennaViennaAustria
| | - G. Kasprian
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - A. Ba‐ssalamah
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - M. Stuempflen
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - E. Kitzmueller
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division of Pediatric CardiologyMedical University of ViennaViennaAustria
| | - D. A. Muin
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal MedicineMedical University of Vienna, ViennaAustria
| | - D. Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center ViennaMedical University of Vienna, ViennaAustria
| | - D. Prayer
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - I. Michel‐behnke
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division of Pediatric CardiologyMedical University of ViennaViennaAustria
| | - B. Ulm
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal MedicineMedical University of Vienna, ViennaAustria
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18
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The pediatric stomach - congenital abnormalities. Pediatr Radiol 2021; 51:2461-2469. [PMID: 34351495 DOI: 10.1007/s00247-021-05155-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 01/19/2023]
Abstract
Diagnostic imaging of the pediatric stomach often provides a challenge for practicing radiologists. Radiologists should be aware of relatively unusual congenital pathology, especially when imaging very young children with gastrointestinal symptoms. We review congenital pathology of the pediatric stomach.
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Shahrouki P, Lee EW, Ruehm S. Polysplenia syndrome and sickle cell trait: extensive deep venous thrombosis from venous stasis and hypercoagulability. Clin Imaging 2021; 82:127-131. [PMID: 34813990 DOI: 10.1016/j.clinimag.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Deep venous thrombosis is a hitherto under-recognized complication occurring in patients with polysplenia syndrome, despite the high prevalence of venous anomalies such as interrupted inferior vena cava (IVC) with azygos/hemiazygos continuation. Here we report the first case of concurrent polysplenia (as evidenced by interrupted IVC with azygos/hemiazygos continuation, multiple left-sided spleens, bowel malrotation with inverted mesenteric veins, preduodenal portal vein, and pancreatic hypoplasia/partial agenesis of the dorsal pancreas) and sickle cell trait, complicated by extensive deep venous thrombosis refractory to medical and interventional radiologic management.
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Affiliation(s)
- Puja Shahrouki
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Stefan Ruehm
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
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20
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Heterotaxy syndrome with accompanying azygos continuation of the inferior vena cava, patent ductus arteriosus and replaced common hepatic artery. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.906752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Kharel S, Koirala DP, Shrestha S, Sedai H, Shrestha BM, Homagain S, Kandel S. Heterotaxy syndrome with complex congenital heart disease, facial palsy, and asplenia: A rare newborn finding. Clin Case Rep 2021; 9:e04573. [PMID: 34401157 PMCID: PMC8347632 DOI: 10.1002/ccr3.4573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Heterotaxy syndrome is associated with asplenia/polysplenia and complex congenital heart disease. Facial palsy in heterotaxy is very rare. The management is still challenging with a poor prognosis. Proper counseling to the family about the disease course, treatment modalities, and outcomes is essential.
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Affiliation(s)
- Sanjeev Kharel
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Dinesh Prasad Koirala
- Department of Gastrointestinal and General SurgeryPediatric Surgery UnitTribhuvan UniversityTeaching HospitalKathmanduNepal
| | - Suraj Shrestha
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Hari Sedai
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | | | - Sushan Homagain
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Suraj Kandel
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
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22
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Ramavathu KVM. Imaging findings in a case of situs inversus totalis. BJR Case Rep 2021; 7:20200202. [PMID: 35047197 PMCID: PMC8749394 DOI: 10.1259/bjrcr.20200202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 02/17/2021] [Indexed: 11/05/2022] Open
Abstract
Situs inversus is an uncommon condition in which there is transposition of thoracic and abdominal structures. We report a case of situs inversus totalis detected incidentally in a 72-year-old female under investigation for haematuria. The imaging findings and role of imaging in this condition have been described in detail. This article emphasises the need for the clinicians to be aware of situs anomalies before planning surgical or radiological interventions in these patients.
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23
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Terra C, Ramos-Andrade D, Sá-Marques I, Brito J, Caseiro-Alves F, Curvo-Semedo L. Duodenal imaging on the spotlight: from A to Z. Insights Imaging 2021; 12:94. [PMID: 34232417 PMCID: PMC8263847 DOI: 10.1186/s13244-021-01045-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions. The majority of the gastrointestinal radiology literature has concentrated on the colon, stomach, and distal small bowel. The duodenum is often overlooked on imaging, namely on CT, but its anatomy (intra and retroperitoneal) and location in such close proximity to other viscera results in involvement by a multitude of primary and secondary processes, some of them exclusive to this bowel segment. While some conditions, like duplications, lipomas, and diverticula, are usually asymptomatic and are incidentalomas that have no pathologic significance, others are symptomatic and very relevant and should be recognized by every general radiologist: development conditions such as annular pancreas and gut malrotation; inflammatory processes such as ulcers and secondary involvement from pancreatitis; neoplastic conditions such as adenocarcinoma, lymphoma, or local extension from adjacent malignancies. They all can be reliably diagnosed with CT. In this article, we demonstrate the typical imaging features of various diseases involving the duodenum, such as developmental, traumatic, inflammatory, infectious, neoplastic, and postsurgical pathologic conditions in alphabetical order, focusing mainly on upper gastrointestinal series (UGIS) and CT but also some radiography, ultrasound, and magnetic resonance (MR) imaging.
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Affiliation(s)
- Carolina Terra
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Daniel Ramos-Andrade
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Ivo Sá-Marques
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Jorge Brito
- Centro Hospitalar do Algarve, Faro, Portugal
| | - Filipe Caseiro-Alves
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
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24
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Tabbara F, Ataya KW, Annous Y, Alamiddine K, Zaghal A. Complicated acute appendicitis in a child with left atrial isomerism: a case report. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Heterotaxy syndrome is a rare clinical entity that is characterized by abnormal visceral organ arrangement in the chest and abdomen. Left atrial isomerism is a subcategory of heterotaxy syndrome characterized by the presence of multiple spleens with or without cardiac anomalies. Patients may remain asymptomatic their whole lives until they are diagnosed incidentally. Given that patients with left atrial isomerism might demonstrate atypical presentations of acute intrabdominal pathologies, it is important to keep a high index of suspicion when encountering such cases.
Case presentation
In this report, we present a case of a 9-year-old boy with a known history of left atrial isomersim who presented with left lower quadrant pain and positive McBurney, psoas, and obturator signs on the left side. A computed tomography scan of the abdomen confirmed the diagnosis of perforated acute appendicitis on the left, which prompted an emergent laparoscopic appendectomy.
Conclusion
Our case highlights the importance of keeping a high index of suspicion for a heterotaxy syndrome that is complicated by acute appendicitis in pediatric patients presenting with vague abdominal pain. Planning the location of trocar placement in patients with situs anomalies is of paramount importance to avoid technical difficulties in laparoscopic procedures.
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25
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Soofi M, Alpert MA, Barbadora J, Mukerji B, Mukerji V. Human Laterality Disorders: Pathogenesis, Clinical Manifestations, Diagnosis, and Management. Am J Med Sci 2021; 362:233-242. [PMID: 34052215 DOI: 10.1016/j.amjms.2021.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/18/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022]
Abstract
Human laterality disorders comprise a group of diseases characterized by abnormal location (situs) and orientation of thoraco-abdominal organs and vessels across the left-right axis. Situs inversus totalis is mirror image reversal of thoraco-abdominal organs/great vessels. Situs ambiguus, better known as heterotaxy, is abnormal arrangement of thoraco-abdominal organs across the left-right axis excluding situs inversus totalis. Heterotaxy, also referred to as atrial or atrial appendage isomerism, is characterized by abnormal location of left-sided or right-sided organs with loss of asymmetry of normally paired asymmetric organs. It is associated with a variety of anomalies involving the heart, great vessels, lungs and intra-abdominal organs. Right and left atrial isomerism are associated with multiple complex congenital cardiac and vascular anomalies, many of which are lethal when untreated. Isomerism may also affect the lungs, spleen, liver, gall bladder, and intestines. Innovative surgical therapy of heterotaxy/isomerism has reduced early mortality and markedly improved long-term prognosis.
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Affiliation(s)
- Muhammad Soofi
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Martin A Alpert
- University of Missouri School of Medicine, Columbia, MO, USA.
| | | | - Basanti Mukerji
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA; Dayton VA Medical Center, Dayton, OH, USA
| | - Vaskar Mukerji
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA; Dayton VA Medical Center, Dayton, OH, USA; Kettering Medical Center, Kettering, OH, USA
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26
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Yadav P, Ajmera P, Krishnamurthy S, Nandivada NB. Heterotaxy Syndrome: Discordant Growth. Cureus 2021; 13:e14766. [PMID: 34094731 PMCID: PMC8164680 DOI: 10.7759/cureus.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Heterotaxy syndrome implies a discordance between placement of thoracic organs with respect to abdominal organs. A large number of these have associated congenital heart defects. This syndrome is unique as every patient is different and can have any permutation and combination of symptoms. In our case, the five-year-old male child presented with complaints of abdominal distension, fever, and bluish discoloration of limbs with even mild exertion. Radiological evaluation was diagnosed with a large atrial septal defect, cardiomegaly, partial pulmonary venous circulation, multiple small spleens on the right side of body, a large midline liver, malrotated bowel, inferiorly displaced kidneys, and two hemiazygos veins. The echocardiography and electrocardiogram too were consistent with atrial septal defect and right ventricular strain pattern. The reasons for this highly variable pattern are rooted in the genetically complicated process of lateralization with a strong link to the copy number variations. Due to the variable patterns, it is more efficient to report all the findings utilizing a step-by-step process of commenting on each and every individual organ, instead of classifying them under different categories based on atrial isomerism. This is important as any other way of classification predisposes to a certain bias.
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Affiliation(s)
- Pratiksha Yadav
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Pranav Ajmera
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sruthi Krishnamurthy
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Nikhil B Nandivada
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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27
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Asymptomatic left isomerism with preduodenal portal vein: computed tomography appearance. Surg Radiol Anat 2021; 43:1425-1429. [PMID: 33847774 PMCID: PMC8042462 DOI: 10.1007/s00276-021-02747-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/03/2021] [Indexed: 12/03/2022]
Abstract
Left isomerism (polysplenia), one of the two major variants of heterotaxia with right isomerism (asplenia), may be rarely diagnosed in adulthood. Most cases are nevertheless asymptomatic and incidentally detected during imaging or surgery performed for unrelated conditions. We hereby report a case of left isomerism fortuitously diagnosed in a 55-year-old man with unrelated tachy-cardiomyopathy. Thoraco-abdominal computed tomography revealed a typical preduodenal portal vein (PDPV) associated with a large series of other occult anatomic variations comprising: polysplenia, agenesis of both pancreatic body and tail, complete non-rotation of the bowel and finally azygous continuation of the inferior vena cava. Subtle but highly specific thoracic features of left isomerism were also found with a bilobed right lung and bilateral long hyparterial main bronchi. The features of adult left isomerism are remembered with special attention to the PDPV.
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28
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The multisystem nature of isomerism: left isomerism complicated by Abernethy malformation and portopulmonary hypertension. Cardiol Young 2021; 31:532-540. [PMID: 33731242 DOI: 10.1017/s1047951121000809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Isomerism, also referred to as "heterotaxy" is a complex set of anatomic and functional perturbations. One of the most obvious manifestations of isomerism is the disturbance of organ arrangement, such that the thoracic organs are no longer asymmetric on the left and right. We report the case of a 14-year-old female in whom exercise-induced dyspnea led to a late diagnosis of left isomerism complicated by Abernethy malformation and portopulmonary hypertension. A comprehensive evaluation revealed two anatomic left lungs and hyparterial bronchi, bilateral left atria, an interrupted inferior caval vein with azygos continuation, multiple spleens, sinus node dysfunction, hepatic hypertrophy with focal nodular hyperplasia, and absence of the portal vein. Pulmonary vasodilator therapy was initiated resulting in clinical improvement. This case exhibits unique features including a late diagnosis of isomerism with Abernethy malformation and portopulmonary hypertension. The patient's presentation, medical workup, and future treatment emphasise the importance of multidisciplinary care in children with complex multisystem disease. We review the multiple cardiac and extracardiac manifestations of isomerism.
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29
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Esmat HA, Naseri MW, Shirzai A. Heterotaxy polysplenia syndrome in an adult female with complete endocardial cushion defect. Radiol Case Rep 2021; 16:1080-1084. [PMID: 33717387 PMCID: PMC7921178 DOI: 10.1016/j.radcr.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/30/2021] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Heterotaxy syndrome is a rare condition characterized by the abnormal arrangement of thoracoabdominal organs across the left-right axis of the body. It is generally classified as right and left atrial isomerism or asplenia and polysplenia syndrome, even though there are overlaps and uncertainties. The diagnosis of isomerism is typically made by echocardiography. However, multidetector computed tomography and MRI can help in obtaining detailed data on the morphology of the heart, great vessels, the anatomy of the internal organs, and their mutual arrangement that make an accurate diagnosis of heterotaxy syndrome. The authors present here the imaging findings of the heterotaxy polysplenia syndrome in a 21-year-old female with a complete endocardia cushion defect and a duplicated right renal vein.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Mohammad Wali Naseri
- Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Asadullah Shirzai
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
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30
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Nadeem M, Tiwari HA, Jambhekar K, Shah H, Ram R. Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1721626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractThe spleen is the largest lymphatic organ and is responsible for both hematological and immunological functions. Several common etiologies such as trauma, developmental variants, infectious/inflammatory conditions, and benign and malignant lesions can occur in the spleen. The role of imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in diagnosing these conditions continues to evolve. The main objective of this review article is to illustrate the role of imaging in identifying the common and uncommon pathology of the spleen.
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Affiliation(s)
- Meshaal Nadeem
- Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hina Arif Tiwari
- Division of Radiology, Department of Medical Imaging, University of Arizona Health sciences, Tuscon, Arizona, United States
| | - Kedar Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hemendra Shah
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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31
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Aumeerally MI, Lin YT, Chua TC. Ambiguous Anatomy and Its Pain. Gastroenterology 2021; 160:e13-e15. [PMID: 32777282 DOI: 10.1053/j.gastro.2020.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Muhammad I Aumeerally
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Coopers Plains
| | - Yi-Tzu Lin
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Coopers Plains
| | - Terence C Chua
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Coopers Plains; School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
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32
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Lee DH. Anatomical resection of lung cancer with isolated left bronchial isomerism: a case report with long-term follow-up. Indian J Thorac Cardiovasc Surg 2020; 36:244-247. [PMID: 33061133 DOI: 10.1007/s12055-020-00934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 10/24/2022] Open
Abstract
An isolated bronchial isomerism without accompanying malformations is known to be very rare and has little clinical problems. There are a few case reports demonstrating that the bronchial isomerism is incidentally found during lung cancer evaluations or surgeries, but none of them have reported the long-term outcomes after lung cancer surgeries. Thoracic surgeons should fully identify the anatomical details of the bronchial isomerism preoperatively to avoid unexpected resection of the wrong bronchi or pulmonary vessels. Herein, we report a rare case of an isolated left bronchial isomerism that was diagnosed preoperatively; the patient safely underwent anatomical pulmonary resection due to lung cancer in the right upper lobe and who has been followed up for >5 years.
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Affiliation(s)
- Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 41944, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
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33
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The Spectrum of Cardiac Anomalies Associated with Heterotaxy: A Single-Center Study of a Large Series Based on Computed Tomography. Pediatr Cardiol 2020; 41:1414-1424. [PMID: 32556488 DOI: 10.1007/s00246-020-02402-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
The aim of the study was to identify and correlate the anatomical variants of cardiac structures among patients with heterotaxy. In this retrospective cross-sectional analysis of 13 years duration, 302 patients of congenital heart diseases associated with heterotaxy were studied. All these patients had undergone a meticulous clinical evaluation, echocardiography, and cardiac computed tomography. The mean age of the cohort was 38.4 months, with 180 males and 122 females. The cohort had 184 patients of right isomerism and 118 of left isomerism. More than half of the cohort had abnormal pulmonary veins. Over 75% of the cohort had low pulmonary blood flow. Abnormal relationship of great arteries was seen in nearly 69% of the cohort. Atrio-venticular canal defect was the commonest anatomical variant. Overall, 43% of the cohort had single ventricle physiology, predominantly associated with right isomerism. Heterotaxy forms a difficult anatomical subset to comprehend due to the plethora of possible abnormalities. However, unless the cardiac and visceral anatomy is delineated well, the surgical plan becomes suboptimal and often elusive, leaving tough choices for cardiac surgeon. It is essential to obtain all the possible anatomical information using additional imaging modalities to devise a basis for a comprehensive plan for medical and surgical management. A better understanding of the genetic and molecular factors in the etiology, coupled with the application of state-of-the-art imaging techniques, is likely to add to our knowledge of heterotaxy to bring about improved surgical outcomes and a better quality of life for patients suffering from this complex entity.
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34
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Doello K, Conde V, Perez MC, Mendoza I, Mesas C, Prados J. Unusual long survival in a case of heterotaxy and polysplenia. Surg Radiol Anat 2020; 43:607-611. [PMID: 32995936 DOI: 10.1007/s00276-020-02586-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Heterotaxy syndrome with polysplenia is an extremely rare congenital disorder caused by a disruption in the embryonic development that results in an abnormal arrangement of the abdominal and thoracic organs. We present the case of a 59-year-old female patient with invasive ductal carcinoma of the right breast (luminal A type) and CT findings of heterotaxy syndrome with polysplenia. The most remarkable anomalies identified were a left inferior vena cava draining into the hemiazygos vein, absent inferior vena cava at the thoracic level, and hepatic veins directly draining into the right atrium. Moreover, an atrial septal defect was identified, explaining the pulmonary hypertension of unknown cause previously detected in the patient. The relevance of this case lies in the unusual anatomical abnormalities found and the large patient survival, having in to account the great rate of heterotaxy syndrome mortality in the first years of life.
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Affiliation(s)
- Kevin Doello
- Medical Oncology Service, Virgen de las Nieves Hospital, 18014, Granada, Spain.,Institute of Biopathologyand Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain
| | - Veronica Conde
- Medical Oncology Service, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Maria C Perez
- Radiological Service, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Inmaculada Mendoza
- Radiological Service, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Cristina Mesas
- Institute of Biopathologyand Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain.,Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071, Granada, Spain.,Instituto Biosanitario de Granada (Ibs. GRANADA), 18014, Granada, Spain
| | - José Prados
- Institute of Biopathologyand Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain. .,Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071, Granada, Spain. .,Instituto Biosanitario de Granada (Ibs. GRANADA), 18014, Granada, Spain.
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35
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Etherton D, Tee L, Tillett C, Wong YH, Yeong CH, Sun Z. 3D visualization and 3D printing in abnormal gastrointestinal system manifestations of situs ambiguus. Quant Imaging Med Surg 2020; 10:1877-1883. [PMID: 32879864 DOI: 10.21037/qims-20-661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Dior Etherton
- Discipline of Physics and Astronomy, School of Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia.,Discipline of Computing, School of Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Lisa Tee
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Carley Tillett
- Curtin Hub for Immersive Visualisation and eResearch (HIVE), Curtin University, Perth, Western Australia, Australia
| | - Yin Hong Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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36
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Joshi BM, Singh S, Kumar A, Sandhu MS, Rana D. Situs Ambiguous Anomaly during Laparoscopic Cholecystectomy in an Adult Female. Niger J Surg 2020; 26:72-77. [PMID: 32165841 PMCID: PMC7041347 DOI: 10.4103/njs.njs_47_183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022] Open
Abstract
Situs anomalies are rare structural defects affecting 0.01% of general population. They present with multisystem structural defects mostly involving cardiovascular, respiratory and GI systems. Situs abnormality with presence of multiple spleen is termed as left atrial isomerism with anatomical and structural differences to its countertype situs ambiguous with asplenia (right atrial isomerism). In this case report, we present an adult case of situs ambiguous anomaly which was diagnosed incidentally during laparoscopic cholecystectomy. The patient had enlarged left lobe of liver, multiple splenules on right side, malrotated small and large gut, interrupted inferior vena cava with azygos continuation, and bilateral bilobed lungs. It is concluded that variations in situs ambiguous cases differ and a single description is not possible. It is crucial to reveal these variations by using imaging modalities and being aware of them prior to surgery and invasive intervention to prevents the possible risks and complications.
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Affiliation(s)
- Brij Mohan Joshi
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Sumitoj Singh
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Ashok Kumar
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Mandeep Singh Sandhu
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Deepak Rana
- Department Radiology, Government Medical College, Amritsar, Punjab, India
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Kesim S, Inanir S. 99m-Technetium-Labeled Red Blood Cells' Single-Photon Emission Computed Tomography/Computed Tomography in Situs Ambiguous with Polysplenia. Indian J Nucl Med 2020; 35:84-86. [PMID: 31949383 PMCID: PMC6958956 DOI: 10.4103/ijnm.ijnm_157_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022] Open
Abstract
Situs ambiguous or heterotaxy syndrome is defined as the abnormal arrangement of organs and vessels within the body. Herein, we present an 8-year-old girl with growing right-sided suprarenal masses mimicking adrenal tumors. Technetium-99-m-radiolabeled red blood cells' planar images were inconclusive for the diagnosis of splenic tissue in the right side. Single-photon emission computed tomography/computed tomography imaging clearly identified right-sided functioning spleens and confirmed the diagnosis of situs ambiguous with polysplenia.
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Affiliation(s)
- Selin Kesim
- Department of Nuclear Medicine, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
| | - Sabahat Inanir
- Department of Nuclear Medicine, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
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Agrawal P, Champaneri B, Jain M, Parmar T, Patel K. Comparison of morphologic profile of congenital heart defects associated with right isomerism and left isomerism in Western Indian population. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_39_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Singh S, Joshi B, Kumar A, Sandhu M, Rana D. Situs ambiguous anomaly during laparoscopic cholecystectomy in an adult female. Niger J Surg 2020. [DOI: 10.4103/njs.njs_47_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Lovell J, Sivakumar J, Wijeratne S. Incidental abdominal heterotaxy syndrome. ANZ J Surg 2019; 90:911-912. [PMID: 31478322 DOI: 10.1111/ans.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/30/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Janaka Lovell
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Victoria, Australia
| | - Jonathan Sivakumar
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Victoria, Australia
| | - Shiran Wijeratne
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Victoria, Australia
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Polysplenia syndrome with situs ambiguous, common mesentery, and IVC interruption discovered incidentally in an adult. Radiol Case Rep 2019; 14:1072-1075. [PMID: 31320964 PMCID: PMC6612708 DOI: 10.1016/j.radcr.2019.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 01/06/2023] Open
Abstract
Polysplenia syndrome associates multiple spleens to other malformations, most frequently cardiac, vascular, visceral, and biliary malformations. Polysplenia has been described mainly in childhood owing to critical anatomic malformations related to cardiac defects or biliary atresia. We present a case of polysplenia syndrome found in a 58-year-old man. Only those with mild anatomical abnormalities reach adulthood without a diagnosis. Radiological examinations are helpful to the diagnosis by ascertaining the location and number of spleens, location of other organs in the chest and abdomen, and identification of other associated anomalies.
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Robot-assisted Toupet fundoplication and associated cholecystectomy in symptomatic giant hiatal hernia with situs viscerum inversus-A case report and literature review. Int J Surg Case Rep 2019; 60:371-375. [PMID: 31288202 PMCID: PMC6614786 DOI: 10.1016/j.ijscr.2019.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/19/2019] [Indexed: 12/30/2022] Open
Abstract
All symptomatic paraesophageal hiatal hernias should be repaired, particularly those with acute obstructive symptoms or which have undergone volvulus. Laparoscopic hiatal hernia repair is as effective as open transabdominal repair, with a reduced rate of perioperative morbidity and with shorter hospital stays. It is the preferred approach for the majority of hiatal hernias. Robotic Assisted Giant-Paraesophageal Hernia repair remain technically challenging predominantly in the dissecation of the hernia sac from the posterior mediastinum. The robotic platform have the same benefits of the laparoscopic approach in terms of complication rate, total surgical time, and hospital length of stay and in particular case is superior.
Introduction Giant hiatus hernia is defined as migration of >30% of the stomach with or without other intra-abdominal organs into the chest. Situs Viscerum Inversus is a rare congenital condition in which the major visceral organs are reversed from their normal arrangement; they are translated (completely or partially) on the opposite side of the body. Diagnosis is often incidental. We report a Robot-assisted Toupet fundoplication for a giant hiatal hernia with gastro oesophageal reflux disease and cholelithiasis, in a 63-years-old woman with situs viscerum inversus. Presentation of case A 63-year-old woman with Situs Viscerum Inversus was diagnosed with giant sliding hiatus hernia. We performed a Robot-assisted procedure of reduction of hiatal hernia in abdomen and Toupet fundoplication with Bio A mesh placement and gastropexy procedure associated to cholecystectomy. The operation time was of 190 min. The patient was discharged on third postoperative day after X-ray check and he tolerated a solid food. Discussion Minimally invasive surgery represents, nowadays, the standard approach for hiatal hernia and cholelithiasis. Conclusion In challenging cases as the giant hernias ad rare anomaly as situs viscerum inversus, the surgical treatment can be facilitated by the use of robotic technology.
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Sobh DM, Batouty NM, Abdelwahab RM, El-Badrawy A, Tawfik AM. Ductus arteriosus location in relation to aortic arch position, branching pattern, and viscero-atrial situs. Clin Radiol 2019; 74:732.e1-732.e8. [PMID: 31200931 DOI: 10.1016/j.crad.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
AIM To investigate ductus arteriosus (DA) location in relation to viscero-atrial situs and branching pattern of the right aortic arch (RAA). MATERIALS AND METHODS Computed tomography (CT) images of paediatric patients (May 2015 to July 2017, n=352) referred for evaluation of cardiovascular malformations were reviewed retrospectively. Patients with RAA were identified and images were analysed for documentation of the viscero-atrial situs, the branching pattern, DA location, and associated malformations. RESULTS The study included 64 RAA patients, 45 situs solitus, 11 situs ambiguous, and eight situs inversus. Mirror-image branching was observed in 34 situs solitus, 11 situs ambiguous, and seven situs inversus patients. Aberrant left subclavian artery (ALSCA) was present in 10 situs solitus and one situs inversus patient. One patient with situs solitus had isolated left subclavian artery. The location of the DA was identifiable in 32 patients (19 left and 13 right). In situs solitus with mirror-image branching, the DA was left in 10, right in four patients. In situs inversus and ambiguous with mirror-image branching, the DA was right in eight and left in two patients. In patients with ALSCA, the DA was left in seven and right in one patient. The location of the DA was identifiable in 85 patients with left aortic arch (left-sided in 84, right-sided in only one patient). CONCLUSION The location of DA in RAA varies according to viscero-atrial situs and branching pattern. In mirror-image branching, the DA is more commonly left-sided with situs solitus and more right-sided with abnormal viscero-atrial situs.
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Affiliation(s)
- D M Sobh
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, El-Gomhoreya Street, Mansoura, Egypt
| | - N M Batouty
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, El-Gomhoreya Street, Mansoura, Egypt
| | - R M Abdelwahab
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, El-Gomhoreya Street, Mansoura, Egypt
| | - A El-Badrawy
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, El-Gomhoreya Street, Mansoura, Egypt
| | - A M Tawfik
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, El-Gomhoreya Street, Mansoura, Egypt.
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Riguetto CM, Pelichek S, Moura A. Heterotaxy syndrome with agenesis of dorsal pancreas and diabetes mellitus: case report and review of the literature. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:445-448. [PMID: 31166366 PMCID: PMC10528644 DOI: 10.20945/2359-3997000000142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/05/2019] [Indexed: 11/23/2022]
Abstract
Heterotaxy syndrome (HS) is a rare congenital condition with multifactorial heritance, characterized by an abnormal arrangement of thoraco-abdominal organs and vessels. Patients present with multiple cardiac, gastrointestinal, hepatosplenic, pancreatic, renal, neurological and skeletal disorders without any pathognomonic alteration. Despite the described increased risk of diabetes mellitus (DM) in patients with altered pancreatic anatomy, just one case was reported in Korea regarding the association of HS and DM in a 13-year-old girl. Our report refers to a 40-year-old female Brazilian patient with a history of DM and HS with polysplenia and agenesis of dorsal pancreas without cardiac abnormalities. She presented a worsening glycemic control associated with weight gain and signs of insulin resistance. After a proper clinical management of insulin and oral medications, our patient developed an improvement in glycemic control. Although it is a rare disease, HS with polysplenia and pancreatic disorders can be associated with an increased risk of DM. This case highlights the importance of investigating DM in patients with HS, especially those with pancreatic anatomical disorders, for proper clinical management of this rare condition.
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Affiliation(s)
- Cínthia Minatel Riguetto
- Universidade Estadual de CampinasUniversidade de CampinasFaculdade de Ciências MédicasDivisão de EndocrinologiaCampinasSPBrasilDivisão de Endocrinologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brasil
| | - Samantha Pelichek
- Universidade Estadual de CampinasUniversidade de CampinasFaculdade de Ciências MédicasDivisão de EndocrinologiaCampinasSPBrasilDivisão de Endocrinologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brasil
| | - Arnaldo Moura
- Universidade Estadual de CampinasUniversidade de CampinasFaculdade de Ciências MédicasDivisão de EndocrinologiaCampinasSPBrasilDivisão de Endocrinologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brasil
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Sabri YY, Yamamah HGAEN, Taymour TA. Role of multislice computed tomography in evaluation of congenital tracheobronchial branching anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lyimo FR, Pallangyo P, Majani N, Mushi TL, Kubhoja S. Complex congenital cardiac anomalies in the setting of right isomerism in a 31-month-old infant: a case report. J Med Case Rep 2018; 12:324. [PMID: 30352615 PMCID: PMC6199716 DOI: 10.1186/s13256-018-1835-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background Congenital cardiac defects are not rare among neonates. Prompt assessment for life-threatening anomalies is essential for rapid management decisions and positive outcomes. Extracardiac anomalies can occur in congenital heart defects, and their presence increases morbidity and mortality in these neonates. Case presentation We report a case of a 31- month-old infant black girl in Tanzania who presented with an on-and-off history of difficulty in breathing, easy fatigability, facial and lower-limb swelling, recurrent respiratory tract infections, and failure to thrive. Conclusions Management of patients with heterotaxy syndrome is complex and largely depends on specific anatomy of both cardiac and noncardiac lesions. Cardiac and noncardiac management must be tailored to individual anatomy, including prophylaxis against encapsulated organisms for asplenic patients.
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Affiliation(s)
- Frederic R Lyimo
- Department of Radiology, Muhimbili National Hospital, P.O. Box, 65000, Dar es Salaam, Tanzania.
| | - Pedro Pallangyo
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
| | - Naizihijwa Majani
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
| | - Theophylly L Mushi
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
| | - Sulende Kubhoja
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
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Baban A, Cantarutti N, Adorisio R, Lombardi R, Calcagni G, Piano Mortari E, Dallapiccola B, Marino B, Iorio FS, Carsetti R, Digilio MC, Giannico S, Drago F, Carotti A. Long-term survival and phenotypic spectrum in heterotaxy syndrome: A 25-year follow-up experience. Int J Cardiol 2018; 268:100-105. [DOI: 10.1016/j.ijcard.2018.02.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/03/2018] [Accepted: 02/13/2018] [Indexed: 11/29/2022]
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Komatsu H, Izumi N, Tsukioka T, Inoue H, Hara K, Miyamoto H, Nishiyama N. Thoracoscopic resection of mediastinal tumor in a patient with azygos continuation of the inferior vena cava. Gen Thorac Cardiovasc Surg 2018; 67:720-722. [PMID: 30229437 DOI: 10.1007/s11748-018-1009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
A 68-year-old man was referred to our hospital because of mediastinal tumor on chest computed tomography (CT). Contrast-enhanced CT showed azygos continuation of the inferior vena cava (IVC). The retro-hepatic IVC was absent superior to the renal veins. The IVC continued into the dilated azygos vein, which joined the superior vena cava. The hepatic vein drained directly into the right atrium. The mediastinal tumor was close to the dilated azygos vein. Video-assisted thoracoscopic resection of the mediastinal tumor was performed, using four ports and CO2 insufflation. Histological examination of the resected specimen revealed a pericardial cyst without malignancy. After a favorable postoperative course, the patient was discharged 4 days after surgery. It is important to recognize this anomaly before thoracic surgery, because transection of the azygos vein can be fatal. Video-assisted thoracoscopic resection of mediastinal tumor close to the azygos vein using CO2 insufflation avoids injury to the azygos vein.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Nobuhiro Izumi
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takuma Tsukioka
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hidetoshi Inoue
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kantaro Hara
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hikaru Miyamoto
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Kim SS, Shin HC, Hwang JA, Jou SS, Lee WH, Choi SY, Park CH. Various congenital anomalies of the inferior vena cava: review of cross-sectional imaging findings and report of a new variant. Abdom Radiol (NY) 2018; 43:2130-2149. [PMID: 29264715 DOI: 10.1007/s00261-017-1430-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The inferior vena cava (IVC) is an important structure receiving a large amount of venous return and is associated with various congenital disorders. Advances in diagnostic imaging and its increasing accessibility have led to an increase in the incidental detection of IVC anomalies. Congenital anomalies of the IVC are not uncommon and are occasionally critical to treatment planning. However, they are frequently overlooked in abdominal imaging. The IVC is composed of four segments (intrahepatic, suprarenal, renal, and infrarenal), and each segment arises from different embryonic structures in a complex process. Anomalies of the IVC can be classified according to the involved segment. Familiarity with the variety of IVC anomalies seen on imaging is vital for correctly diagnosing and managing patients in daily practice.
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Affiliation(s)
- Seung Soo Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Hyeong Cheol Shin
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea.
| | - Jeong Ah Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Sung Shick Jou
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Woong Hee Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
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