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2010-09-10-13 Answer to the case of the week #284 © Binodini
Answer to the case of the week #284

January 6, 2011 - January 20, 2011.

Binodini M. Chauhan, MD.

Surat, India.

Case report

This is a case of 24-year-old G5 P4 who was referred to our center for the ultrasound finding of dextrocardia. Patient had non-contributive personal or family history.

We performed an ultrasound at 21 weeks of gestation. Thoracic anomalies included:
  • Dextroposition of the heart
  • Heart was shifted to the extreme right, with apex pointing to the right
  • Normal 4-chamber-view and outflow tracts
  • Aorta descending on the left
  • Mild pericardial effusion
  • Right lung not visible, left lung of normal appearance

Our diagnosis based on the ultrasound findings was right lung agenesis which explained the dextroposition of the heart.

Patient opted for pregnancy termination due to an adverse prognosis for the fetus.

Images 1,2: Image 1 shows a normal 3D - image of the fetal face. Image 2 shows normal posterior fossa.

Images 3,4: Images show the heart shifted to the right with axis deviated to the right. Left lung is of a normal appearance.


Images 5,6: Images show heart shifted to the right, aorta descending on left, arrow indicates slight pericardial effusion.


Images 7,8: Image 7 shows stomach on the left and left descending aorta. Image 7 shows heart on the right, right lung is not visible.

Images 9,10: Image 9 shows Doppler demonstrating filling of both ventricles during diastole. Image 10 shows intact diaphragm which rules our diaphragmatic hernia as a cause of dextroposition of the heart.

Video 1 - 4: Videos showing dextroposition of the heart, left descednding aorta, normal looking left lung and absent right lung.


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