Niger J Paed 2014; 41 (3): 251 –253  
Garba BI  
Adelakun MB  
Aminu MS  
Onazi SO  
Musa A  
Incidental finding of dextrocardia  
with situs inversus totalis in a day  
old neonate: Case report and  
review of the literature  
Sule MB  
Accepted: 10th April 2013  
Abstract: Dextrocardia with situs  
inversus are rare congenital anoma-  
lies which can be asymptomatic  
and compatible with normal life.  
They are characterized by mirror  
images of all intra-thoracic and  
intra-abdominal viscera. Our aim is  
to report an incidental finding of  
dextrocardia with situs inversus in  
a neonate with neonatal sepsis. A  
day-old male term neonate pre-  
sented with features of infection.  
Physical examination revealed car-  
diac apex on the 4th right intercos-  
tal space, along the mid-clavicular  
line. Chest radiograph and abdomi-  
nal ultrasound confirmed the diag-  
nosis of dextrocardia with situs  
inversus. Bilateral cervical ribs  
were also seen on chest radio-  
graph. He was managed with anti-  
b i o t i c s a n d d i s c h a r g e d .  
Newborn babies should have a  
thorough physical examination  
after delivery before discharge to  
enable early diagnosis of congeni-  
tal anomalies for appropriate refer-  
Garba BI (  
Adelakun MB  
Department of Paediatrics,  
Aminu MS  
Department of Medicine  
Yariman Bakura Specialist Hospital,  
Tudun Wada round about, PMB 1010,  
Gusau, Zamfara State.  
Onazi SO  
Department of Paediatrics  
Federal Medical Centre, Gusau.  
Key words: Dextrocardia,  
neonate, neonatal sepsis.  
Musa A  
Department of Paediatrics  
Ahmadu Bello University Teaching  
Hospital, Zaria.  
Sule MB  
Department of Radiology  
Usmanu Danfodio University Teaching  
Hospital, Sokoto.  
Case report  
Dextrocardia (also called looping defect) is an abnormal  
congenital positioning of heart on the right side . Situs  
A 24 hour old male term neonate presented with com-  
plaints of refusal to suck, fever, convulsion and bloody  
stool of few hours duration. He had associated abdomi-  
nal distension, but no vomiting or bleeding from any  
other site. Pregnancy was supervised, uneventful, no  
maternal risk factors of sepsis. Delivered at a general  
hospital and cried immediately after birth. He was not  
examined by a paediatrician after delivery as none is  
available at the hospital.  
inversus totalis also called situs transversus, is a con-  
genital condition in which major visceral organs are  
reversed or mirrored from normal positions. Many peo-  
ple with situs inversus are unaware of their unusual con-  
genital anomaly until they seek medical attention for  
unrelated conditions . Individuals with dextrocardia and  
situs inversus totalis may have associated congenital  
heart malformations ,3 primary ciliary dyskinesia or  
splenic malformations.  
On examination he was not febrile and not pale. Cardio-  
vascular system examination reveathled full volume  
pulses, regular with apex beat at 4 right intercostal  
space mid clavicular line. He had normal heart rate with  
first and second heart sounds. Abdomen was full, soft,  
not tender and no organ was palpable. Rectal examina-  
tion revealed finger stained with bloody stool.  
We describe a case of dextrocardia with situs inversus  
totalis in a one day old neonate with neonatal sepsis, the  
first case to be reported in Gusau, Zamfara State, Nige-  
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  
are implicated.  
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  
our hospital  
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-  
Authors contributions  
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 :  
Literature review.  
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  
Funding: None  
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