An unknown situs viscerum inversus totalis, accidentally discovered after computed tomography

Abstract

Benign situs inversus totalis of the viscerum is often diagnosed accidentally, rarely in adults, and more frequently in children and neonates, affecting both sexes. In this report, a young female patient accidentally discovered a situs inversus totalis after computed tomography for acute abdominal pain. In this uncommon anatomical abnormality, the major visceral organs are reversed in the opposite direction. This report highlights the importance of being aware of and considering situs inversus in clinical practice, particularly when interpreting imaging findings and planning medical procedures. This is critical for differential diagnosis and comorbidities that may affect those patients.

The cause of situs inversus totalis is still unknown; however, this condition is frequently asymptomatic, particularly in infants, and is sometimes associated with other syndromes. The patient arrived at the emergency department with left flank pain, nausea, and fever. In the first ultrasonography, a strange anatomy was suspected; thus, a contrasted computed tomography was performed. The patient had never had a computed tomography scan before. The identification of situs inversus totalis was unexpected and coincidental; the computed tomography images were carefully examined. In patients with chest or abdominal pain, clinicians may consider situs inversus totalis based on computed tomography, particularly if without clinical and imaging history. This knowledge can help in the differential diagnosis, avoiding unneeded interventions. Moreover, comorbidities that affect several systems, particularly cardiovascular and pulmonary systems, affect quite a few patients with situs inversus totalis, who require careful examination and lifelong monitoring.

Keywords

computed tomography / diagnostic imaging / situs inversus totalis / viscerum inversus / anatomic variation / dextrocardia / left-sided gallbladder / left-right asymmetry / mirror-image transposition

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