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The descending aorta and inferior vena cava are on the same side of the spine.In left isomerism, or polysplenia, bilateral left-sidedness occurs.Of these patients, 80% have a right-sided aortic arch.Situs inversus with levocardia is rare, Kartagener syndrome is typified by bronchiectasis, sinusitis, and situs inversus and affects 20% of patients with situs inversus; however, only 50% of patients with Kartagener syndrome have situs inversus.A trauma patient with evidence of external trauma over the ninth to eleventh ribs on the right side is at risk for splenic injury.If surgery is planned on the basis of radiographic findings in a patient with situs inversus, the surgeon should pay careful attention to image labeling to avoid errors such as a right thoracotomy for a left lung nodule.The location and relationships of the following should be reviewed carefully: abdominal viscera, hepatic veins, superior vena cava, inferior vena cava, coronary sinus, pulmonary veins, cardiac atria, atrioventricular connections and valves, cardiac ventricles, position of the cardiac apex, and aortic arch and great vessels.

The 2 primary subtypes of situs ambiguous include (1) right isomerism, or asplenia syndrome, and (2) left isomerism, or polysplenia syndrome.The cardiac apex points to the right, but the viscera are otherwise in their usual positions.Situs inversus with dextrocardia is also termed situs inversus totalis because the cardiac position, as well as the atrial chambers and abdominal viscera, is a mirror image of the normal anatomy.Situs solitus is the normal position, and situs inversus is the mirror image of situs solitus (see the image below).Cardiac situs is determined by the atrial location.

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