Page 386 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-032
The Role of Plain Radiography in the Diagnosis of Situs Inversus

1
2
Vidya Sushanti , Naela Fadhila , Evita Karianni Bermanshah 2
1
2
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Situs inversus is a term used to describe the inverted position of chest and abdominal organs.
In the most common situation, situs inversus totalis, it involves complete transposition (right to left reversal)
of all of the viscera. An uncommon form of situs inversus is isolated levocardia, in which the position of the
heart is not mirrored alongside the other organs. There is a 5-10% prevalence of congenital heart disease in
individuals with situs inversus totalis, most commonly transposition of the great vessels. The incidence of
congenital heart disease is 95% in situs inversus with levocardia. Plain radiography is the best initial imaging
tool that allows for assessment of situs inversus. Objective To describe the role of plain radiography in the
diagnosis of situs inversus. Case A preterm 35-weeks infant was born by emergency C-section because of
fetal bradycardia and polyhydramnion. On a physical examination, showed a broad forehead, a depressed
nasal bridge, distended abdomen. The baby was not active, has recurrent cyanosis and desaturation. Due
to progressive respiratory distress, the infant required noninvasive support ventilation. A chest radiograph
demonstrates dextrocardia, complete situs inversus and suspect duodenal atresia. Echocardiography shows
pulmonary atresia, single functional atrium, single functional ventricle, dextrocardia mirror image, and
small PDA. Abdominal ultrasound shows liver in the left side of abdomen while spleen and gaster in the
right side. Conclusion Plain radiography can be used as the initial modality for the evaluation of situs
inversus. Echocardiography and ultrasound are mandatory imaging tools to evaluate cardiovascular and
other abnormality of the abdomen.
Keywords: situs inversus; preterm; plain radiography

P-PI-033
The Radiologic Evaluation of Coat-Hanger Appearance in Chest X-Ray

1
Vidya Sushanti , Nitish B. Adnani , Haryanti F. Wulandari , Damayanti R. Sjarief 1
1
2
1
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
2
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Nowadays, there are many possible ways to test for a wide range of genetic abnormalities.
Radiology plays a role in guiding the geneticist to concentrate their attention on particular chromosomes/
genes. Some conditions may have pathognomonic radiographic appearances, allowing the radiologist to
make a confident diagnosis. The “coat-hanger” sign of the ribs with a bell-shaped thorax has been known
as a radiological hallmark of one of genetic abnormalities, which is Kagami-Ogata syndrome, a clinically
recognizable paternal uniparental disomy 14 (upd(14)pat). Recognition of the coat-hanger rib configuration
can be helpful for genetic testing and for clinical decision making. Objective To evaluate coat-hanger
appearance in chest X-Ray. Case An infant boy was born at 38 weeks of gestation by C-section due to
polyhydramnion. On a physical examination, showed a broad forehead, funnel chest, and distended abdomen.
The baby was not active and dyspnea, thus required noninvasive support ventilation for more than 10 days.
The baby has suffered of feeding problem and recurrent vomitus during hospitalization. At the age of 5 days,
patients underwent fracture of the left femur. A chest radiograph demonstrate a bell-shaped thorax and coat-
hanger appearance. Echocardiography shows normal heart and abdominal ultrasound examination shows
no abnormalities. Conclusion The coat-hanger sign was quantitatively represented by coat-hanger angle,
and was found to be more severe than that seen in other genetic bone diseases. Thus, the findings will help
in the diagnosis of upd(14)pat.
Keywords: coat-hanger appearance; Kagami-Ogata syndrome; chest X-Ray

338 KONIKA XVIII Abstract Book