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Myocardial Perfusion SPECT Imaging in Dextrocardia with Situs Inversus: A Case Report
Olusegun Akinwale Ayeni1, Nico Malan1, Emmanuel Niiboye Hammond1
1Division of Nuclear Medicine and Molecular Imaging, Department of Radiation Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
Insights
Dextrocardia, a heart anomaly, can occur with situs inversus totalis. This case highlights challenges in diagnosing coronary artery disease (CAD) using myocardial perfusion scintigraphy in patients with dextrocardia.
Area of Science:
- Cardiology
- Medical Imaging
- Genetics
Background:
- Dextrocardia is a rare congenital anomaly where the heart is positioned in the right chest.
- Situs inversus totalis involves a complete mirror-image reversal of thoracic and abdominal organs.
- Dextrocardia can occur independently or as part of situs inversus.
Observation:
- A 35-year-old male with diagnosed situs inversus totalis and dextrocardia presented for coronary artery disease (CAD) evaluation.
- Coronary artery disease incidence and presentation in dextrocardia patients are similar to the general population.
- Myocardial perfusion scintigraphy was utilized for CAD diagnosis.
Findings:
- The case underscores the importance of careful myocardial perfusion scintigraphy (MPS) acquisition and analysis in patients with dextrocardia.
- Potential pitfalls in MPS data processing and interpretation were identified in this unique patient population.
- Despite anatomical variations, CAD presentation in dextrocardia mirrors that of the general population.
Implications:
- Accurate interpretation of cardiac imaging is crucial for effective CAD management in patients with dextrocardia.
- This case emphasizes the need for specialized protocols in nuclear cardiology for patients with congenital heart malpositions.
- Understanding imaging challenges in dextrocardia improves diagnostic accuracy and patient care for this rare condition.
Abstract:
Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base-to-apex axis directed to the right and caudad. Situs inversus is an autosomal recessive disorder that causes organs in the chest and abdomen to be positioned in a mirror image from their normal position. Dextrocardia may occur in isolation or as part of situs inversus. Similarly, situs inversus may occur with or without dextrocardia. Situs inversus accompanied with dextrocardia (situs inversus totalis) is a rare congenital abnormality occurring in 0.01% of live births. Herein, we present the case of a 35-year-old man with previously diagnosed situs inversus totalis with mirror-image dextrocardia, referred to our facility for diagnosis of coronary artery disease (CAD). The incidence and presentation of CAD in patients with dextrocardia are similar to the normal population. However, considerable attention should be paid to the acquisition of myocardial perfusion scintigraphy and data processing/analysis in this group of patients. The present case highlights the distinctive applications and potential pitfalls of myocardial perfusion single-photon emission computed tomography (SPECT) imaging in patients with dextrocardia.
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