Incidental diagnosis of situs inversus totalis: a perspective from an emergency department attendance

2021 ◽  
Vol 14 (4) ◽  
pp. e242337
Author(s):  
Umma-Kulthum Abdullahi Umar ◽  
Aysha Najim Alremeithi ◽  
Hasan Qayyum
Keyword(s):  
Emergency Department ◽  
Situs Inversus ◽  
Anatomical Variation ◽  
Vital Signs ◽  
Situs Inversus Totalis ◽  
Cardiac Complications ◽  
X Rays ◽  
Future Health ◽  
Normal Limits ◽  
Chest X Ray

A 30-year-old man of African origin presented to our emergency department (ED) with subjective fever and abdominal pain which started on the day of attendance. Vital signs and systemical examination were within normal limits. As part of his evaluation in ED, a 12-lead electrocardiogram was performed which showed features consistent with dextrocardia later confirmed on a chest X-ray as well. An ultrasound scan of the abdomen was performed which showed mirror imaging of the abdominal viscera, all of which were otherwise structurally normal. A diagnosis of situs inversus totalis was made. The patient’s symptoms resolved with analgesia and he was discharged with advice to follow-up in our hospital’s outpatient department. The diagnosis of situs inversus in the ED is a tricky one to make and most cases of this condition are discovered incidentally, as in our case. The mirror-imaged arrangement of viscera can have implications on the site of localised complaints, the physical examination, future health problems for the patient including anaesthesia risks, chronic lung conditions, cardiac complications and specialised trauma management. This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.

scholarly journals The Role of Acetyl Cysteine in Cocaethylene (Non-Acetaminophen) Acute Liver Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Getaw Worku Hassen ◽  
Amaninder Dhaliwal ◽  
Catherine Ann Jenninigs ◽  
Hossein Kalantari
Keyword(s):  
Emergency Department ◽  
Substance Abuse ◽  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Active Substance ◽  
Vital Signs ◽  
Normal Limits ◽  
History Of ◽  
Acetyl Cysteine

Background.Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.Case Presentation.A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.Conclusion.In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.

scholarly journals Double Rarity: Malignant Masquerade Biliary Stricture in a Situs Inversus Totalis Patient. A Case Report

2020 ◽  
Author(s):  
Katalin Eitler ◽  
Zoltan Mathe ◽  
Veronika Papp ◽  
Attila Zalatnai ◽  
Andras Bibok ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Situs Inversus ◽  
Anatomical Variation ◽  
Significant Risk ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Situs Inversus Totalis ◽  
Recent Onset ◽  
Benign Biliary Strictures ◽  
Duct Stricture

Abstract Background. Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7-18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is difficult. Case presentation. We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy and a hepatico-jejunostomy has been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well.Conclusion. In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. The surgery is usually unavoidable, involving a significant risk of complications.The co-existence of these two difficult diagnostic and therapeutic features made our case challenging.

scholarly journals Unscheduled return visits by patients to a german emergency department are a high risk group for initial wrong diagnosis

2018 ◽  
Vol 17 (4) ◽  
pp. 178-181
Author(s):  
Felix Ludwig ◽  
◽  
Wilhelm Behringer ◽  
Steffen Herdtle ◽  
Christian Hohenstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Risk Group ◽  
Vital Signs ◽  
High Risk Group ◽  
Normal Limits ◽  
Wrong Diagnosis ◽  
Return Visits ◽  
Special Patient Population ◽  
Special Patient

The aim was to classify patients who returned unscheduled to an emergency department within 7 days. We categorized the patients’ cases arbitrarily according to the underlying cause of the return. The main causes for returning unscheduled were: “patient related” (24,2%), “illness related” (35,4%), “physician related” (18,3%), “system related” (3,8%) and “other” (21,7%). We also analyzed missed diagnoses, as the literature describes this special patient population as a high risk group. 15,4% of all return cases had a wrong diagnosis. No typical risk constellation/symptom could be found. Vital signs or blood values were within normal limits as well.

scholarly journals Right Hemihepatectomy via an Anterior Approach for Hepatocellular Carcinoma in a Situs Inversus Totalis Patient

2020 ◽  
Vol 14 (1) ◽  
pp. 91-97
Author(s):  
Rong-Dang Fu ◽  
Jie-Yuan Li ◽  
Xiao-Hong Zhang ◽  
Huan-Wei Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Situs Inversus ◽  
Anterior Approach ◽  
Middle Hepatic Vein ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Right Hemihepatectomy ◽  
Glissonian Approach ◽  
Congenital Condition ◽  
Chest X Ray

Situs inversus totalis (SIT) is a rare congenital condition in which the usual position of the organs is reversed from left to right as a mirror image of the normal situation. Due to the abnormal transposition, this represents a technical challenge for the surgeon. In the present study, right hemihepatectomy via the anterior approach was performed for a 68-year-old hepatocellular carcinoma (HCC) patient with SIT. SIT was diagnosed by chest X-ray and computed tomography. The tumors were located in segments VIII and VI of the liver, and there was no metastasis to the lymph nodes and distant organs. Hemihepatic vascular inflow occlusion was performed using the selective intra-Glissonian approach. The middle hepatic vein was preserved under the guidance with intraoperative ultrasonography. The present case suggests that right hemihepatectomy via the anterior approach may be a safe, feasible, and effective procedure for HCC patients with SIT.

scholarly journals The influence of chest X-ray results on antibiotic prescription for childhood pneumonia in the emergency department

2021 ◽  
Author(s):  
Josephine S. van de Maat ◽  
Daniella Garcia Perez ◽  
Gertjan J. A. Driessen ◽  
Anne-Marie van Wermeskerken ◽  
Frank J. Smit ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Treatment Decisions ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
Tract Infections

AbstractThe aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic prescription in children suspected of lower respiratory tract infections (RTI) in the emergency department (ED). We performed a secondary analysis of a stepped-wedge, cluster randomized trial of children aged 1 month to 5 years with fever and cough/dyspnoea in 8 EDs in the Netherlands (2016–2018), including a 1-week follow-up. We analysed the observational data of the pre-intervention period, using multivariable logistic regression to evaluate the influence of CXR result on antibiotic prescription. We included 597 children (median age 17 months [IQR 9–30, 61% male). CXR was performed in 109/597 (18%) of children (range across hospitals 9 to 50%); 52/109 (48%) showed focal infiltrates. Children who underwent CXR were more likely to receive antibiotics, also when adjusted for clinical signs and symptoms, hospital and CXR result (OR 7.25 [95% CI 2.48–21.2]). Abnormalities on CXR were not significantly associated with antibiotic prescription.Conclusion: Performance of CXR was independently associated with more antibiotic prescription, regardless of its results. The limited influence of CXR results on antibiotic prescription highlights the inferior role of CXR on treatment decisions for suspected lower RTI in the ED. What is Known:• Chest X-ray (CXR) has a high inter-observer variability and cannot distinguish between bacterial or viral pneumonia.• Current guidelines recommend against routine use of CXR in children with uncomplicated respiratory tract infections (RTIs) in the outpatient setting. What is New:• CXR is still frequently performed in non-complex children suspected of lower RTIs in the emergency department• CXR performance was independently associated with more antibiotic prescriptions, regardless of its results, highlighting the inferior role of chest X-rays in treatment decisions.

scholarly journals Cholecystitis in Situs Inversus with Dextrocardia

2018 ◽  
Vol 3 (2) ◽  
pp. 87
Author(s):  
Mohammad Ali Raza Qizalbash ◽  
Rida Zahra ◽  
Adnan Adil Mithwani ◽  
Anwar Adil Mithwani ◽  
Muaaz Adil Mithwani ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Emergency Department ◽  
Case Report ◽  
Acute Cholecystitis ◽  
Situs Inversus ◽  
Open Cholecystectomy ◽  
Situs Inversus Totalis ◽  
The Body ◽  
Rare Congenital Anomaly ◽  
Left Hypochondrium

Background: Surgical problem known as Acute Cholecystitis is very common nowadays; however it may cause trouble in diagnosing when person has situs inversus, (i.e.) viscera situated on the opposite side of the body. Our case report discusses the history and physical exam findings, images of radiograph, diagnosis, and how we dealt with cholecystitis in situs inversus with dextrocardia.Case Presentation: An eighty-six yrs. old male having pain in the upper left hypochondrium region, presented in emergency department. He was later diagnosed to have acute cholecystitis (inflammation of the gallbladder) with cholelithiasis (presence of gallstones in gallbladder) in situs inversus totalis. Patient underwent elective open cholecystectomy within 24 h. Patient recovered well and was discharged on fourth postoperative day.Conclusion: Acute cholecystitis in Situs Inversus with Dextrocardia is very rare congenital anomaly and requires great expertise in the field of surgery to operate on these patients because of the reverse anatomy of the organs.

scholarly journals Situs Inversus Totalis: From Anatomical Variation to Clinical Studies

2015 ◽  
Vol 29 (S1) ◽  
Author(s):  
Gregory Casey ◽  
Lisa Campeau ◽  
Diptasri Mandal ◽  
Alyssa Russell
Keyword(s):  
Situs Inversus ◽  
Clinical Studies ◽  
Anatomical Variation ◽  
Situs Inversus Totalis

Ultrasound for Endotracheal Tube Tip Position in Term and Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Sabrina Salvadori ◽  
Daniel Nardo ◽  
Anna Chiara Frigo ◽  
Martina Oss ◽  
Irene Mercante ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Neonatal Intensive Care ◽  
Vital Signs ◽  
X Rays ◽  
Right Pulmonary Artery ◽  
Chest X Ray ◽  
Tip Position ◽  
The Right ◽  
A Prospective Study ◽  
Mean Time

<b><i>Background and Objective:</i></b> Placing an endotracheal tube (ETT) in neonates is challenging and currently requires timely radiographic confirmation of correct tip placement. The objective was to establish the reliability of ultrasound (US) for assessing ETT position in the neonatal intensive care unit (NICU), time needed to do so, and patients’ tolerance. <b><i>Methods:</i></b> A prospective study on 71 newborns admitted to our NICU whose ETT placement was evaluated with US (ETT-echo) and confirmed on chest X-rays (CXR). Data were collected by 3 operators (2 neonatologists and a resident in pediatrics). The right pulmonary artery (RPA) was used as a landmark for US. The distance between the tip of the ETT and the upper margin of the RPA was measured using US and compared with the distance between the tube’s tip and the carina on the CXR. <b><i>Results:</i></b> Seventy-one intubated newborns were included in the study (<i>n</i> = 34 &#x3c; 1,000 g, <i>n</i> = 18 1,000–2,000 g, <i>n</i> = 19 &#x3e; 2,000 g). Statistical analysis (Bland-Altman plot and Lin’s concordance correlation coefficient) showed an excellent consistency between ETT positions identified on US and chest X-ray. The 2 measures (ETT-echo and CXR) were extremely concordant both in the whole sample and in the subgroups. Minimal changes in patients’ vital signs were infrequently observed during US, confirming the tolerability of ETT-echo. The mean time to perform US was 3.2 min (range 1–13). <b><i>Conclusions:</i></b> ETT-echo seems to be a rapid, tolerable, and highly reliable method worth further investigating for future routine use in neonatology with a view to reducing radiation exposure.

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