title: [Situs inversus totalis - 2 case reports].
abstract: BACKGROUND
  Situs inversus totalis is a rare find and only a small percentage are associated with heart disease; its diagnosis is usually made incidentally.
  
  
  OBJECTIVE
  To discuss the diagnostic features of situs inversus totalis and the importance of early diagnosis.
  
  
  METHODS
  Two pediatric patients aged 9 and 14 years who were incidentally diagnosed are reported. The first case presented chest pain and during cardiac auscultation, increased heart sounds were heard on the right precordium and attenuated on the left. An electrocardiogram (ECG) showed P wave and QRS axis equal to +150°, narrow QRS voltage attenuated in V3-V6 precordial leads, and negative T waves in leads V1-V4 and aVL. Chest radiography confirmed dextrocardia, and gastric bubble was on the right and hepatic shadow on the left. Echocardiography showed classic mirror dextrocardia without associated malformations. In the second case, dextrocardia was found incidentally after radiography was requested for the evaluation of scoliosis. ECG showed QRS of +120°, P wave axis of +150° and narrow QRS voltage axis attenuated on left precordial leads. Doppler echocardiography confirmed dextrocardia without associated anomalies. Abdominal ultrasound found the liver in left upper quadrant and the spleen in right upper quadrant.
  
  
  CONCLUSIONS
  Early diagnosis of situs inversus totalis is important because the thoracic and abdominal surgical approach is different and certain diseases could be presented with unusual characteristics. Also, after the diagnosis of situs inversus, the presence of associated pathologies such as primary ciliary dyskinesia can be studied (Kartagener syndrome).
authors.forename: María
authors.initials: M
authors.lastname: Juncos C
authors.forename: María Amparo
authors.initials: MA
authors.lastname: Ros F
authors.forename: María
authors.initials: M
authors.lastname: Maravall Ll
authors.forename: Julio
authors.initials: J
authors.lastname: Álvarez-Pitti
mesh_terms: D000293:Adolescent; D002637:Chest Pain / Q000209:etiology; D002648:Child; D003914:Dextrocardia / Q000175:diagnosis*; D042241:Early Diagnosis; D004562:Electrocardiography; D006801:Humans; D033162:Incidental Findings; D007619:Kartagener Syndrome / Q000175:diagnosis*; D008297:Male; D012857:Situs Inversus / Q000175:diagnosis*