ROLE OF 128-MDCT SCAN IN DIAGNOSING CONGENITAL HEART DISORDERS USING 3 SEGMENT NOTATION IN SITUS INVERSUS, LEVO-LOOP, LEVO-MALPOSITION OF THE BLOOD VESSELS ACCOMPANIED WITH MORPHOLOGICAL DOUBLE OUTLET RIGHT VENTRICLE CASE
Situs inversus is an anatomical configuration in which the organ arrangement is upside down compared solitus sites. Situs inversus is a rare congenital disorder. CT scan is a modality of choice for a definite diagnosis of situs inversus. The diagnosis of situs inversus is carried out using segmental approach with 3 segments notation of Van Praagh, which includes determining the visceroatrial sites, directions ventricular-loop and position toward large vessels. A case was reported that a male, age 19 years, with a chief complaint of shortness of breath, has been diagnosed with situs inversus and examined with MDCT. The test results showed the diagnosis of situs inversus, levo-loop, levo-malposition of great vessels (I, L, L-MGV) with atrioventricular concordance and morphologic double outlet on the right ventricle. Additionally, the image also showed subaortic ventricular septal defect and sub valvular pulmonic stenosis with dilatation of the stenotic post on the main pulmonary artery and the main branch of the pulmonary artery bilateral proximal portion. Several other abnormalities were also found, including pericardial effusion, dilation of the right hepatic vein, the media and the left hepatic vein as well as obstruction to the flow of the contrast in the superior vena cava and inferior and azygos veins that with dilatation of the morphologic right atrium and morphologic right ventricle which is likely due to heart failure, as well as anomalies of descendens aorta. Situs inversus imaging using 128-MDCT scans are important to be performed for intra-operative details such as visceral organs position, the apex of the heart, and the branches of the large blood vessels and error in identification of disordered structure can be avoided.
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