PMC5894323_01
Thoraco-abdominal radiograph showing over-distended, right-sided stomach (red arrow) with narrow thoracic cage and short horizontally oriented ribs
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F1
A thoraco-abdominal radiograph obtained in the emergency department revealed dextrocardia with a right sided over-distended stomach, narrow thoracic cage, and short horizontal ribs [Figure 1].
Plain radiograph of the thorax shows a narrow thorax, short, horizontally oriented ribs with expanded anterior ends (yellow arrows), "handle-bar" appearance of clavicles (white arrows) along with dextrocardia. Over-distended stomach is seen on the right side of the abdomen (red arrow)
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F2
On skeletal survey, the chest radiograph revealed narrow thorax, short, horizontally oriented ribs with expanded anterior ends, "handle-bar" appearance of clavicles along with dextrocardia [Figure 2].
Plain radiograph of the abdomen shows gastric air lucency on the right side of the abdomen (white arrow) and the nasogastric tube (red arrow) curving along the right side of the abdomen indicating a situs disorder. Short iliac wings with sharp sacro-sciatic notches and "trident" appearance of acetabulae (yellow arrows) are seen. There is paucity of large bowel loops in their normal peripheral location
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F3
Additionally, short iliac wings, sharp sacro-sciatic notches, spiky spur-like protrusions of iliac bone (resulting in trident appearance of the acetabula) were seen [Figure 3].
Upper gastrointestinal contrast radiograph obtained at 5 min shows an over-distended stomach located on the right side with a normal pyloric canal
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F4
The barium series study revealed a right-sided over-distended stomach without any radiological signs of hypertrophic pyloric stenosis [Figure 4].
Upper gastrointestinal contrast radiograph obtained at 5 h shows delayed gastric emptying. The duodenal loop (white arrow) is seen in a mirror configuration. Opacified jejunal loops are seen on the right side of the abdomen. Air-filled large bowel is seen in the midline of the abdomen (green arrow)
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F5
Subsequent radiographs showed significantly delayed gastric emptying till 5h, along-with dextroposition of the duodeno-jejunal junction and the duodenal loop [Figure 5].
Delayed radiograph obtained 24 h after contrast administration shows large bowel loops appear to be located entirely in the midline of the abdomen
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F6
On 24 h delayed radiographs, the "picture frame" appearance of large bowel was absent and the large bowel loops were seen in the midline of the abdomen [Figure 6].
PMC5894323_02