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【读片】产科疑难超声病例（298）：内脏反位合并镜面右位心

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上一病例：【读片】产科疑难超声病例（297）：宫颈妊娠

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Case report

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This is a case of a 21-year-old G1P0 with unremarkable personal or family history.
Her ultrasound scans at 15 and 18 weeks of gestation were reported as normal. She returned at 22 weeks for the cardiac scan. The ultrasound exam showed the following findings.
患者21岁，G1P0，无明显既往病史和个人史。孕15周和18周超声检查未见异常。孕22周进行胎心超声检查发现如下：

Images 1-10: 22 weeks.

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2011-07-21 23:39 浏览 : 13950 回复 : 155

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xihuansushi 编辑于 2011-08-09 23:17

• (求大佬指点）医学专硕毕业，四证合一，在深圳找得到工作吗

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Case report

This is a case of a 21-year-old G1P0 with unremarkable personal or family history.
Her previous ultrasound scans at 15 and 18 weeks of gestation were reported as normal. She returned at 22 weeks for the cardiac scan. The ultrasound exam did not show any fetal anomalies. Both stomach and heart were on the same side. Careful second-look examination detected situs inversus. The fetus was cephalic, longitudinal lie, with it's left side posterior and right side anterior, closer to the transducer. Both stomach and heart were located on the right side. There were no other associated anomalies detected.

Situs inversus was missed on both previous ultrasound exams. This diagnosis is very rare, incidence is 1:10.000 pregnancies. The assessment of the fetal visceral situs should be the first step in the cardiac ultrasound exam. Situs inversus is associated with a slight increase of the complex congenital heart disease. 20% of cases with situs inversus are affected by Kartagener syndrome which involves ciliary function causing recurrent respiratory infections and reduced fertility. [1]

患者21岁，G1P0，无明显既往病史和个人史。孕15周和18周超声检查未见异常。孕22周进行胎心超声检查未发现胎儿存在任何结构异常。胃泡与心脏位于同侧，再仔细扫查发现存在内脏反位，胎儿呈头位，其左侧位于后方，右侧位于前方靠近探头。胃泡与心脏位于胎儿躯体的右侧，其他未见异常。

内脏反位在先前两侧次的超声检查时未能发现，其非常罕见，妊娠期的发病率约1:10000。在胎儿心脏超声检查时应首先确定其内脏位置。内脏反位时发生复杂性先心病的几率略有增加，20%的内脏反位出现在Kartagener综合症，此综合症常表现为纤毛功能受损从而导致反复发作的呼吸道感染和生育力下降。

Images 1,2: Image 1 shows the fetal head in the cephalic presentation with head near the uterine cervix. Image 2 shows the axial view of the head.
图1显示胎儿呈头位，胎头靠近宫颈；图2为胎头轴切面。
Images 3,4: Image 3 shows the sagittal view of the fetus shows the longitudinal lie with spine posterior. Image 4 shows the fetal face.
图3为胎儿矢状面，显示脊柱位于后方；图4为胎儿面部。

Image 5,6: Image 5 shows the normal 4-chamber-view, apex of the heart is pointing to the right side, closer to the ultrasound probe. Image 6 shows the color Doppler of the heart.
图5为正常四腔心切面，心尖指向右侧，靠近探头；图6为心脏多普勒图像。

Image 7,8: Images show the stomach on the same side as the heart, both on the right.
图像显示心脏与胃泡同在右侧。

Images 9,10: Image 9 shows normal looking femur bone. Image 10 shows a color Doppler of umbilical artery demonstrating a three-vessel cord.

图9显示胎儿正常股骨；图10为正常三血管脐带的血流图。

Video: Video shows the ultrasound sweep from the maternal pelvis towards the rib cage. The fetus is in cephalic presentation, spine posterior, with the right side of the fetus close to the transducer. Both heart and stomach are located on the right.

视频显示超声扫查平面从母体盆腔向胸腔方向。胎儿呈头位，脊柱位于后方，胃泡与心脏位于右侧，临近探头。

2011-08-05 18:07

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xihuansushi 编辑于 2011-08-05 18:29

• 一年又半-深圳入职后

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