Dextroposition of the Heart

Abstract : An 18-year-old male recruit underwent a physical examination to assess fitness for enrollment into the Naval Academy. There was no health complaint. His medical history was significant for a pectus excavatum. His surgical history was notable only for a cosmetic repair of the pectus at age 14. Review of systems included an ability to participate in athletics without limitation. His admission physical exam documented only ?a left chest wall 6 cm scar consistent with surgical history.? The screening chest x-ray is presented below (Fig 1A). Technical limitations impeded a thorough echocardiographic evaluation and a cardiac magnetic resonance imaging (MRI) study was performed to determine whether the condition represented dextroposition, true mirror-image dextrocardia, or a more sinister culprit such as corrected transposition of the great arteries (Fig. 1B, coronal; Figs. 1C, 1D and 1E, axial cranial to caudal).