1. To learn how to identify a patient with HLAI based on chest X ray findings. 2. To be aware of the steps needed following the diagnosis of HLAI.

The orderly arrangement of the truncal organs is called situs solitus. Heterotaxy, implies a disordered organ arrangement in the chest or abdomen. It can be complete (situs inversus) or partial (situs ambiguous). Situs ambiguous, also called heterotaxy syndrome, is an arrangement of internal organs somewhere between situs solitus and situs inversus. That condition is not usually diagnosed or expected in adult patients because it is associated to serious anomalies and discovered in infancy. We wish to report a group patients with laevocardia and abdominal inversion,...

Five patients with HLAI were discovered between 2014 and 2018 (Figues Fig. 1 , Fig. 2 , Fig. 3 , Fig. 4 and Fig. 5 ). All of them had a left-sided heart and a right stomach bubble. Most of them have a prominent azygos vein. Out of five three had enhanced CT and one had a barium small-bowel study. The remaining patient had only chest and abdominal radiographs. All patients were asymptomatic. Two of them were discovered in preoperative chest radiographs and another two...

Right gastric bubble associated to an enlarged azygous lobe should lead to suspect HSLAI in the chest radiograph. Congenital heart disease might be less frequent than published in patients with HSLAI but referral these patients to the cardiology team is indicated.

1.Jo DS, Jung SS, Joo CU.b A case of unusual visceral heterotaxy syndrome with isolated levocardia. Korean Circ J. 2013; 43:705-9. 2. Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002; 179:1429-35. 3. Applegate KE, Goske MJ, Pierce G, Murphy D. Situs revisited: imaging of the heterotaxy syndrome. Radiographics. 1999;19:837-52.

Alberto Villanueva East Surrey Hospital [email protected]