1 / 36

Case Study

Case Study. A. Swartbooi Diagnostic Radiology, UFS 9 March 2012. Patient Info. 46 yr old male pt Known cardiac pt Previous Mitral valve replacement Complaint of dyspnoea and orthopnoea. Clinical Presentation. Chronically ill (RVD on Rx) Pulse & Temp N BP 110/80 Blood results N.

tilden
Download Presentation

Case Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study A. Swartbooi Diagnostic Radiology, UFS 9 March 2012

  2. Patient Info • 46 yr old male pt • Known cardiac pt • Previous Mitral valve replacement • Complaint of dyspnoea and orthopnoea

  3. Clinical Presentation • Chronically ill (RVD on Rx) • Pulse & Temp N • BP 110/80 • Blood results N

  4. ImagingCXR

  5. ImagingCXR • Findings: • Dextrocardia • Cardiomegaly • Post Sternotomy wires • Right gastric air bubble • Left sided liver • Left lower pleural disease

  6. ImagingHeart Sonar • Findings • Dextrocardia • Global hypokinesia • EF 32%

  7. Diagnosis • Dextrocardia with situs inversus

  8. Investigations • Further evaluation in pt with abovementioned chest findings include: • Abdominal ultrasound • If inconclusive • CT abdomen • MRI • Angiography

  9. Imaging • Critical structures for evaluation of situs • Cardiac apex • Atria • Lungs (bi- or trilobed) • Subdiaphragmatic venous Drainage • Aorta relative to midline • Stomach position (? malrotation) • Liver and gallbladder • Spleen (presence, appearance, number)

  10. Imaging modalities • Chest x-ray • Plain chest and abdominal x-rays are the first imaging modalities • Presence or absence of normal situs • Evaluate heart • Stomach air bubble • Liver outline

  11. Imaging modalities • Ultrasound • Evaluate intra-abdominal solid organs • Spleen • Liver • Vasculature • Relation of large vessels

  12. Imaging modalities • Transthoracic echocardiography • Directly visualize cardiovascular anomalies • CT • MRI • Angiocardiography (Less commonly used)

  13. Introduction • Situs anomalies are often confusing, in part because of the overlapping features of some anomalies • NB to understand the terminology • Situs refers to the position of the heart and viscera relative to midline.

  14. Terminology • Situs Solitis • Situs inversus • Situs ambiguous/Heterotaxy

  15. Situs Solitus • Situssolitus • Represents the normal position of the heart and abdominal viscera, with the cardiac apex, spleen, stomach, and aorta located on the left and the liver and inferior vena cava (IVC) located on the right • Congenital heart disease occurs in less than 1% of individuals with situssolitus • In case of dextrocardia 95% chance of CHD

  16. Situs Solitus

  17. Situs Inversus • SitusInversus • Indicatesmirror-image location of the organs compared to situssolitus • NB to recognize • May help avoid mishaps at surgery or other interventions, particularly in the emergency setting • Two major subcategories • Situsinversus with dextrocardia • Situsinversus with levocardia

  18. Situs Inversus

  19. Situs Inversus • Situsinversus with dextrocardia • Situsinversustotalis • More common • Heart and viscera relative to situssolitus • Cardiac apex, spleen, stomach, and aorta located on the right and the liver and IVC located on the left • 3-5 % chance of CHD

  20. Situs Inversus

  21. Situs Inversus • Situsinversus with levocardia • Extremely rare • Mirror-image location of the viscera relative to situssolitus and a left-sided cardiac apex • 95 % chance of CHD

  22. Heterotaxy • Heterotaxy syndrome • Rare condition that occurs in approximately 0.8% of patients with congenital heart disease • Abnormal arrangement of organs and vessels as opposed to the orderly arrangement typical of situssolitus and situsinversus

  23. Heterotaxy • Patients with heterotaxy syndrome have a high probability of having severe complex cardiovascular anomalies (50 – 100%) • Characterized not by a single set of abnormalities but by a spectrum of abnormalities • Encompasses 2 groups of diseases • Asplenia • Polysplenia

  24. Heterotaxy • Situs ambiguous with asplenia • aKa Right isomerism or bilateral right-sidedness • Findings include • BilatTrilobed lungs (minor fissures bilat) • Eparterial bronchi • Bilat left atria • Central liver • Stomach position indeterminate • Absent spleen • IVC and Aorta on same side of vertebra **

  25. Heterotaxy

  26. Heterotaxy • Situs ambiguous with asplenia • 99%–100% prevalence of congenital heart disease • Common cardiac anomalies • Common atrioventricular canal • Univentricular heart • TGA • TAPVR • More in males • Death in 1st yr of life up to 80% • Asplenia related to greater risk for sepsis • Carefull search for spleen NB

  27. Heterotaxy • Asplenia

  28. Heterotaxy • Situs ambiguous with polysplenia • aKa Left isomerism or bilateral left-sidedness • Findings include • Bilatbilobed lungs • Bilatpulm atria • Central liver • Stomach position indeterminate • Multiple spleens • IVC interuption with continuation of azygos system • No single anomaly is pathognomonic

  29. Heterotaxy

  30. Heterotaxy • Situs ambiguous with polysplenia • Cardiac anomalies less common and less complex (50-90%) • Most common cardiac anomalies • PAPVR • ASD • Atrioventricular canal • More in females

  31. Heterotaxy • Polysplenia

  32. Summary

  33. Summary • Situs anomalies are often detected incidentally, with ⇧ frequency, in adults during imaging evaluation for unrelated conditions • It is important for radiologists to become familiar with these anomalies, the spectrum of their manifestations, and their significance • Not all patients with heterotaxy present with the classic features of either asplenia or polysplenia

  34. Summary • Nb to utilize an individualized approach in these patients reflecting the unique anatomy • eg. Heterotaxy syndrome (bilateral bilobed lungs, levocardia, left sided malrotated stomach) • A complete, correct anatomic diagnosis cannot only lead to earlier intervention, but also provide some indication of prognosis

  35. THANK YOU

  36. References • RadioGraphics 2002; 22:1439–1456 • RadioGraphics 1999; 19:837-852 • American Journal of CardiologyVolume 81, Issue 2, Pages 188-194 , 15 January 1998 • Dahnert. Radiology Review Manual, page 593-594 • Weisleder. Primer of Diagnostic Radiology, page 139-140

More Related