Had a patient today during the tutorials.
18 year old girl
Came in with sore throat, fever, SOB, productive cough.
Has a background history of recurrent chest infections. Almost once every month.
So we asked a few questions.
At first thinking that this cud be cystic fibrosis, or bronchiectasis, or some sort of chronic lung disease, or immunosuppression.
The we were told to examine the cardivascular exam.
So we did.
Started at the Aortic area, fine, Pulmonary area, fine, Tricuspid area fine, the Mitral area.......silence..i cudn't hear anything. HMM..maybe i got the wrong spot.so i moved up a little bit.Still nothing. Being that it was a young girl, i was quite hesitant to explore further, assuming it was just me that cudn't hear it. But then my 2 collegues said they could hear it at the apex beat. I was more puzzled.
The we auscultated the basal lung areas. Definitely reduced air entry at the RIGHT side.Infact, it was almost silent. So we thought, fine, probably theres a pleural effusion there.
So after finishing we went out to discuss the findings with the Registrar. So she confirmed my findings, much to the bemusement of my two collegues that there was definitely no sound at the apex beat.
"So where is it then?" she asked. Lets look at the x-ray she said.
Lo n behold, there it was, the heart, on the RIGHT side of the lung. I smiled at Mr. S who confidently said he heard a heart sound at the apex beat which was on the left.
Apparently, this was a case of probably an apparent dextrocardia, not a true one.
Possible Kartagener's Syndrome (situs inversus, chronic sinusitis, bronchiectasis)
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