PMC8274694_01
Electrocardiogram, Chest X-Ray, and Echocardiography. A. Standard 12-lead electrocardiogram showing right axis deviation and positive QRS complexes in lead aVR, inversion of lead I, and absent R-wave progression in the chest leads, suggestive of dextrocardia.B. Chest X-ray (PAview) showing cardiac apex and fundal gas shadow on the right suggestive of dextrocardia with situs inversus. C. 2D-echocardiography subcoastal view confirming situs inversus (IVC to the right (blue) and aorta on left (red)).
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ECG revealed a right axis deviation, with a positive QRS complex in lead aVR suggestive of dextrocardia (Fig. 1A). Chest X-ray subsequently confirmed dextrocardia with situs inversus (Fig. 1B). Echocardiography revealed situs inversus (Fig. 1C), dextrocardia with hypokinesia of the apical, anterior, and anterolateral segments.
Coronary angiography, A. P-A cranial angulation & B. RAO caudal angulation showing a linear radiolucent defect in LAD extending from proximal to mid-segment (black arrows). C. RAO cranial angulation after using the horizontal axis inversion angiographic mode.
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Coronary angiography revealed a linear radiolucent defect in the proximal to mid-segment of the left anterior descending artery (LAD) (Fig. 2.
Optical coherence tomography findings (Short axis). A. Usual atherosclerotic change with a fibrous plaque and significant diametric stenosis (MLA 2.4 mm2), B. Intracoronary "Honeycomb appearance", C & D. Multiple tram track channels with the presence of plaque rupture at 2 'o'clock, E. Extension of the channels with intraluminal thrombus within at 7 and 9 'o'clock, F. Usual atherosclerotic narrowing of the true lumen with false lumen seen at 7 'o'clock.
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B). Based on the angiographic profile, differential diagnosis of spontaneous coronary artery dissection or recanalized thrombus was considered, and for further evaluation, OCT was performed using Dragonfly OPTIS catheter (Abbot-USA) which confirmed significant stenotic lesion with plaque rupture and extensive left anterior descending artery thrombosis with multiple channels showing the characteristic and very unusual honeycomb-like structure (Fig. 3).