Am Fam Physician. 2014 Jul 1;90(1):47-48.
A 24-year-old asymptomatic man requested a chest radiograph for routine tuberculosis screening. He did not have difficulty breathing, palpitations, chest pain, or edema. His medical history was significant for scoliosis and Rubinstein-Taybi syndrome, a rare genetic condition that causes short stature, broad thumbs and toes, hirsutism, and often intellectual disabilities.
On examination, his lungs were clear to auscultation. He had a regular heart rate and rhythm with no murmurs. There was no jugular venous distension. The heart sounds were shifted to the right, and the apical impulse was located to the right of the sternum. There were normal pulses in all four extremities. Chest radiography was performed (see accompanying figure).
Based on the patient's history, physical examination, and radiography findings, which one of the following is the most likely diagnosis?
C. Right heart failure.
D. Situs inversus totalis.
Author disclosure: No relevant financial affiliations.
Address correspondence to David Garcia, CAPT, MC, USAF, at email@example.com. Reprints are not available from the authors.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force Medical Department or the U.S. Air Force at large.
1. Moore KL, Arthur FD, Agur AM. Clinically Oriented Anatomy. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2006.
2. Bohun CM, Potts JE, Casey BM, Sandor GG. A population-based study of cardiac malformations and outcomes associated with dextrocardia. Am J Cardiol. 2007;100(2):305–309.
3. Longo DL. Harrison's Principles of Internal Medicine. New York, NY: McGraw-Hill; 2012.
4. Wolfgang D. Radiology Review Manual. Philadelphia, Pa.: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.
5. Hennekam RC. Rubinstein-Taybi syndrome. Eur J Hum Genet. 2006;14(9):981–985.
6. Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2007.
7. Carlson BM, Kantaputra PN. Human Embryology and Developmental Biology. 5th ed. Philadelphia, Pa.: Saunders; 2014.
Contributing editor for Photo Quiz is John E. Delzell, Jr., MD, MSPH.
A collection of Photo Quizzes published in AFP is available at http://www.aafp.org/afp/photoquiz.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to firstname.lastname@example.org.
Copyright © 2014 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions