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.
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