A rare association of ruptured left middle cerebral artery aneurysm and dextrocardia with situs inversus totalis

Abstract

The association of dextrocardia with situs inversus totalis and ruptured cerebral aneurysm is a rare event. There have been no reports concerning this rare association in the literature. Asymmetric positioning of internal organs is one of the characteristics of vertebrates. The normal left–right anatomic positioning, situs solitus, does not occur normally always, leading to laterality defects. In this letter, we describe the clinical course of a patient with a ruptured aneurysm of the left middle cerebral artery and dextrocardia with situs inversus totalis, and discuss the radiological importance with the help of literature review of pathogenesis of this rare association. A 57-year-old woman was hospitalized with sudden onset of headache and nausea with a score on the Glasgow Coma Scale of 15 (E4V5M6). A computed tomography (CT) revealed subarachnoid hemorrhage. Routine chest X-ray on admission revealed dextrocardia. Serial angiography disclosed the right carotid artery and the right vertebral artery emanating directly from the aorta, and the left carotid artery and the left vertebral artery branching off from the left innominate artery (Fig. 1). The cannulation of the bilateral carotid and vertebral arteries was difficult due to this anomalous branching. Cerebral angiography showed a ruptured aneurysm of the right middle cerebral artery (Fig. 2).