Total situs inversus: a rare anomaly presenting to a chiropractic teaching clinic.

OBJECTIVE: The purpose of this article is to describe a patient with a previously undiagnosed rare anomaly, total situs inversus (TSI), and discuss the range of clinical presentations and complications associated with this and other situs anomalies. An emphasis is directed toward educating the clinician concerning the potential diagnostic challenges posed by patients with TSI and the need for patient education. CLINICAL FEATURES: The patient was a 26-year-old white woman who presented to a chiropractic teaching clinic for a scoliosis evaluation and underwent full-spine radiography. The cardiac silhouette and gastric air bubble were evident on the right side. INTERVENTION AND OUTCOME: Radiography including a 2-view chest and 1-view abdomen series was performed. Examination showed a complete mirror image presentation of the cardiothoracic and visceral organs. The patient was informed of her diagnosis and associated complications and counseled concerning how typical health complaints may present atypically in patients with situs anomalies. The patient has not experienced complications associated with the TSI.
CONCLUSION: Total situs inversus is a rare autosomal recessive anomaly. This article highlights the classification and nomenclature of situs anomalies and their clinical presentations and complications. In addition, the importance of thorough patient education and counseling in those with situs anomalies is emphasized.