This is chest X ray of a 3 months
old baby boy who presented with history of rapid breathing for 2 day duration
associated with URTI symptoms.
On examination, patient is
tachypnoeic with respiratory rate of 60, central cyanosis, nasal blockage and
SPO2 of 90% under room air. otherwise, non septic looking and active.
cardiovascular examination reveals palpable apex beat at right chest region,
pan systolic murmur grade 3. Lung examination reveals good and equal air entry
bilaterally with transmitted sound. Expiratory phase is prolong. No crepitation
or rhonci noted.
Chest X ray shows hyper inflated
lung with perihilar haziness and dextrocardia. A diagnosis of acute
bronchiolitis with underlying cyanotic congenital heart disease (not in
failure) was made.
Prior to that, at three weeks of
life, he presented with cough, fever and bluish discoloration of body and treated
with bronchopneumonia with underlying heart problem.
one month earlier, he presented
with unprovoked cyanotic spell.
ECHO was done and noted finding of
complex cyanotic heart disease consisting of situs solitus dextrocardia, large
muscular apical ventricular septal defect, double outlet right ventricle,
transposition of great arteries and pulmonary stenosis
More on Dextrocardia:
Image of the Day 11: The Missing
Heartbeat [Link]
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