Chest X-ray showed normal heart size with apex located
to the right in keeping with dextrocardia. Hepatic
shadow was noted on the left and possible splenic
shadow on the right. There were cervical ribs bilaterally.
Abdominal scan demonstrated liver on the left while the
spleen was on the right. Demonstrable bowel loops were
slightly distended but otherwise normal.
Full blood count showed leucocytosis, random blood
sugar and serum electrolytes were normal. Blood culture
did not yield any growth. Cerebrospinal fluid analysis
was in keeping with bacterial meningitis and gram nega-
tive cocobacilli were seen on microscopy. However,
cerebrospinal fluid culture yielded no growth.
tus. This is due to the fact that dextrocardia with situs
inversus is merely a mirror image of the normal situs
solitus, hence any associated cardiac malformations are
usually mirror images of similar malformations in
people with the normal situs solitus. In isolated dextro-
cardia, in which the heart is on the right side without
inversion of the abdominal viscera, malformations of the
heart are almost always invariably present. It has been
postulated that even though the factors responsible for
situs inversus are not clear autosomal recessive gene,
maternal diabe5t,e6s, cocaine use and conjoined twinning
A case of dextrocardia with situs inversus occurring
early in life has only been reported in a three day old
neonate . Some cases of dextrocardia have been reported
Fig 1: Radiograph
showing the cardiac
apex pointing to the
right and the hepatic
shadow on the left.
in Nigerian children and adults which were mostly inci-
dental findings. Ekpe al reported on dextrocardia with
situs inversus co existing with neonatal intestinal ob-
struction in a three day old neonate. A 14 year old child
was incidentally found to have dextrocardia with situs
inversu8s when he was evaluated for chronic sinusitis at
Danbauchi and Alhassan . in Zaria reported two cases
of dextrocardia with situs inversus; a 35-year-old man
that presented for the first time with respiratory symp-
toms but no cardiac symptoms and a 14-year-old who
presented with cardiac symptoms.
Echocardiography was not done as it is not available in
Diagnosis of early onset neonatal sepsis with meningitis
was made with background Dextrocardia and situs soli-
tus inversus. He was managed on nil per os, antibiotics,
anticonvulsants and intravenous fluid; however blood
trtahnsfusion was not required. Bloody stool stopped on
Dextrocardia with situs inversus have also been reported
in cadav0ers in medic1a1l schools during dissection in
Nigeria and India. An unusual occurrence of dextro-
cardia with situs inversus have been reported in two
generations of families in India; affecting a fath2er and
his two sons following consanguineous marriage.
day of admission and he remained stable and was
discharged by 10 day. Echocardiography in another
centre was not done by the parents as requested and
baby was lost to follow up at age of 3 months despite
adequate counselling of parents.
An incidental finding of dextrocardia with situs inversus
in a newborn is reported and the need for clinicians to
have high index of suspicion is highlighted due to its
asymptomatic nature. Clinicians should look for this
anomaly when reporting or viewing chest x-rays. New-
born babies should have a thorough physical examina-
tion after delivery before discharge to enable early diag-
nosis of congenital anomalies for appropriate referral.
Dextrocardia with complete situs inversus is rare,
usually discovered incidentally in otherwise normal sub-
jects . Mirror-image dextrocardia with situs 1i,2nversus
occurs in 1 in 10, 000 of the general population.
Most neonates delivered in the hospitals are not exam-
ined especially by paediatricians as is the case of this
index baby, to detect such cases in neonatal period. It
may be discovered in infancy because of associated
anomalies but often remains asymptomatic and discov-
Garba BI and Aminu MS: Conceptualised the case
ered by chance in adult life. Many people with this con-
dition are unaware of their unusual anatomy until they
seek medical attention for an unrelated condition. This
Onazi SO, Musa A, Adelakun MB and Sule MB :
anomaly may not be diagnosed until late life in some
cases and it is associated w3ith primary ciliary dyskinesia
and splenic malformations.
Sule MB Ultrasound.
Garba BI and Aminu MS: Manuscript writing
Conflict of interest: None
It has been shown that the incidence of congenital heart
malformations is higher in patients with dextrocardia
and situs inversus than in patients with normal situs soli-