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 Table of Contents     
CASE REPORT
Year : 2012  |  Volume : 27  |  Issue : 4  |  Page : 252-253  

Myocardial perfusion scintigraphy in a case of dextrocardia: Doing it "right"


1 Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication23-Jul-2013

Correspondence Address:
Bhagwant Rai Mittal
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.115398

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   Abstract 

We present the challenges in performing the stress test and acquisition of images in myocardial scintigraphy in a 54-year-old female patient with dextrocardia. Dextrocardia and situs inversus were documented on prior investigations including a chest roentgenogram and sonography.

Keywords: Dextrocardia, situs inversus, SPECT, Tc99m-tetrofosmin


How to cite this article:
Kashyap R, Abrar M, Bhattacharya A, Rohit MK, Mittal BR. Myocardial perfusion scintigraphy in a case of dextrocardia: Doing it "right". Indian J Nucl Med 2012;27:252-3

How to cite this URL:
Kashyap R, Abrar M, Bhattacharya A, Rohit MK, Mittal BR. Myocardial perfusion scintigraphy in a case of dextrocardia: Doing it "right". Indian J Nucl Med [serial online] 2012 [cited 2019 Dec 8];27:252-3. Available from: http://www.ijnm.in/text.asp?2012/27/4/252/115398


   Introduction Top


Dextrocardia is a rare congenital abnormality with incidence of 0.01% of live births. [1] The heart is positioned in the right hemithorax in this condition unlike the normal left sided position. Performance of myocardial perfusion imaging (MPI) to acquire optimal images can be challenging in this condition. We describe the intricacies and pitfalls in one such case of dextrocardia.


   Case Report Top


A 54-year-old type 2 diabetic and hypertensive female patient with dextrocardia and situs inversus was referred for evaluation of coronary artery disease. The patient underwent treadmill test with Bruce protocol. The electrocardiogram with the leads placed conventionally [Figure 1]a shows P inversion in the lead 1 inverted QRS complexes in lead 1 with right axis deviation and equivocal and non-progressive R waves in the precordial leads. Reversal of the leads shows upright P and QRS in lead 1 with normal QRS progression in chest leads [Figure 1]b. Chest X-ray also showed cardiac shadow on the right side [Figure 1]c. At the peak stress, Tc99m-tetrofosmin (370MBq) was injected. Following the stress, tomographic imaging was carried out under a dual head gamma camera (Infinia hawkeye-4, General Electricals, Milwaukee, USA) with a low dose computed tomography (140 mV, 2 mA) for attenuation correction. Images were acquired in L mode over 180° starting from right posterior oblique to left anterior oblique projections instead of the standard right anterior oblique to left posterior oblique views. Rest images were acquired on the same day after reinjection of tracer. The images show findings of situs inversus and dextrocardia [Figure 1]d. Reversible perfusion defect was also noticed in the free wall (antero-lateral segment as per conventional nomenclature). Attenuation correction in this case shows the severity and extent of defect to be less as compared to uncorrected images suggesting an attenuation artefact [Figure 1]e.
Figure 1: Features of dextrocardia (a) electrocardiography (ECG) of the patient with the leads placed conventionally showing P wave and QRS inversion in lead I and non-progression of QRS complex in precordial leads (b) ECG of the same patient with the placement of leads reversed (c) chest X-ray of the patient showing dextrocardia (d) maximum intensity projection of the patient showing dextrocardia with situs inversus and (e) SPECT images showing reversible perfusion defect in the antero-lateral segment of the patient.

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   Discussion Top


Dextrocardia is a rare congenital abnormality with incidence of 0.01% of live births. [1] The term mirror image dextrocardia is used in case of dextrocardia with normal vascular connections along with situs inversus. Few reports of MPI in a patient with dextrocardia exist. [2],[3],[4],[5] In their review, Burrell and MacDonald [6] suggest acquisition of images from −135° to +45° position. We have acquired from −45° to +135°. Similar acquisition has also been carried out by Turgut et al. [4] and therefore, also gives effective results. Due to the rare incidence of this anamoly, it is difficult to exactly demonstrate, which method of acquisition is better. Situs inversus may also be seen in association with Kartagener syndrome. Kartagener syndrome is a disorder of ciliary motility and presents with recurrent sinusitis, otitis media, bronchiectasis and situs inversus. [7] The index patient had isolated dextrocardia with situs inversus without Kartagener syndrome. It is necessary for both the technologist and physician to be aware of dextrocardia and note the "right way" of acquisition of electrocardiography and single photon emission computed tomography images.

 
   References Top

1.Evans WN, Acherman RJ, Collazos JC, Castillo WJ, Rollins RC, Kip KT, et al. Dextrocardia: Practical clinical points and comments on terminology. Pediatr Cardiol 2010;31:1-6.  Back to cited text no. 1
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2.Yusuf SW, Durand JB, Lenihan DJ, Swafford J. Dextrocardia: An incidental finding. Tex Heart Inst J 2009;36:358-9.  Back to cited text no. 2
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3.Thomas GS, Kawanishi DT. Situs inversus with dextrocardia in the nuclear lab. Am Heart Hosp J 2008;6:60-2.  Back to cited text no. 3
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4.Turgut B, Kitapci MT, Temiz NH, Unlü M, Erselcan T. Thallium-201 myocardial SPECT in a patient with mirror-image dextrocardia and left bundle branch block. Ann Nucl Med 2003;17:503-6.  Back to cited text no. 4
    
5.Slart RH, de Boer J, Jager PL, Piers DA. Added value of attenuation-corrected myocardial perfusion scintigraphy in a patient with dextrocardia. Clin Nucl Med 2002;27:901-2.  Back to cited text no. 5
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6.Burrell S, MacDonald A. Artifacts and pitfalls in myocardial perfusion imaging. J Nucl Med Technol 2006;34:193-211.  Back to cited text no. 6
[PUBMED]    
7.Gregory T, Steven EW. Bronchiectasis and lung abscess. In: Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, et al., editors. Harrison's Principles of Internal Medicine. 17 th ed. New York: McGrawHill; 2008. p. 1629-32.  Back to cited text no. 7
    


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