Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, February 02, 2006

    Last week our X-ray technician came marching up the hall toward me, waving a set of films. She was somewhat upset: "They won't take this film! They say I did it wrong, and I didn't!"

    I didn't recognize the name on the films. "Is this my patient?" I asked.

    "No, but it's a pre-op and the radiology department is giving me a hard time. They say I put the markers on the film backwards, or something."

    I glanced at the chest X-ray in question and immediately got her point. Normally the heart is situated to the left of center, with the apex pointing to the left. (To the reader's right; the convention is to look at the film as if the person were standing in front of you.) This film showed the heart neatly reversed, pointing to the right.

    "Ahh. Dextrocardia," I purred. "I haven't seen this in a long time."

    I now had a small audience of medical assistants and office staff staring at the film. "What's that?"

    "Dextrocardia," I explained, "is when the heart is on the opposite side of the chest. A guy in my med school class had this." (True.) "Send the film back," I added, "it's OK."

    ADDENDUM: I had just posted this when I checked back with the technician; it turned out it wasn't dextrocardia after all, she had just taken the film using a different technique due to the patient's size. We all got confused (including me). Still, I hate to waste a good post, and it could have turned out to be dextrocardia - you do see anomalies once in awhile. Has anybody out there seen dextrocardia or situs inversus on a routine X-ray?



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