Heterotaxy Polysplenia Syndrome in Adulthood: Focused Review and a Case Report

Pheochromocytoma in a patient with heterotaxy syndrome: a case report

BACKGROUND

Heterotaxy syndrome is a rare congenital condition characterized by abnormal arrangement of thoracoabdominal organs, often associated with complex cardiac and splenic anomalies. Pheochromocytoma is a rare neuroendocrine tumor that overproduces catecholamines, leading to various complications. The co-occurrence of heterotaxy syndrome and pheochromocytoma has not been previously reported. This case report presents a unique finding of pheochromocytoma in a patient with heterotaxy syndrome and a functioning ectopic spleen, offering novel clinical insights.

CASE PRESENTATION

A 19-year-old male with congenital heart disease was incidentally found to have a right adrenal mass during abdominal ultrasonography which followed abnormal lab results. Computed tomography (CT) scans confirmed abnormal organ positioning consistent with heterotaxy syndrome, including a midline liver, right-sided colon, and the absence of a spleen in its typical location. Subsequent scintigraphy with Technetium-99 m denatured red blood cells revealed a functioning ectopic spleen in the left subdiaphragmatic space. The right adrenal mass was confirmed to be pheochromocytoma based on elevated urinary catecholamine levels. Despite recommendations for surgery, the patient chose medical management with alpha-blockers and remained stable over a one-year follow-up with no significant events.

CONCLUSIONS

This case is notable concurrency of pheochromocytoma and heterotaxy and for the rare occurrence of a functioning ectopic spleen in a patient with heterotaxy syndrome, a condition where splenic anomalies typically manifest as asplenia or polysplenia. The importance of extensive imaging, particularly Tc-99 m labeled denatured erythrocyte scintigraphy imaging, is emphasized, as routine imaging like CT scans may fail to detect ectopic organs. Additionally, the concurrent presence of pheochromocytoma (PCC) and heterotaxy syndrome, although rare, raises intriguing questions about their potential link. While this case does not explore the association in detail, chronic hypoxia caused by congenital cardiovascular anomalies in heterotaxy syndrome could activate hypoxia-inducible factors (HIFs), which may promote tumorigenesis, including the development of PCC. Future studies are warranted to explore these mechanisms further and clarify the pathophysiological connection between heterotaxy syndrome, hypoxia, and PCC.

Polysplenia with situs inversus totalis, azygos continuation of the inferior vena cava, and duplication of the superior vena cava in a healthy adult: A case report

Polysplenia syndrome is an embryological disorder whereby the usual left-right asymmetry of thoracic and abdominal viscera fails to develop. It is a rare entity, estimated to occur at a frequency of 1 in 40,000, and is often associated with cardiac and biliary abnormalities. More than 75% of patients die before the age of 5 years, and even in the absence of cardiac anomalies, only 5%-10% of patients are expected to survive into adulthood without complications. Although polysplenia syndrome encompasses a wide range of anatomic abnormalities, there is no single pathognomonic feature. Hence, the prognosis of patients with polysplenia depends on their anatomy, thus necessitating radiology in their management. Here we present a case of a 56-year-old man with polysplenia syndrome and situs inversus totalis. This presentation is atypical because polysplenia is usually considered a form of situs ambiguus, and cases with situs inversus totalis are exceedingly rare. Also noted in our patient are variations in the great vessels, including aortic arch branches and the venae cavae which are features not typically associated with either polysplenia syndrome or situs inversus totalis. The patient is healthy and asymptomatic at baseline, with his diagnosis being made incidentally. Our case report is the first to describe this unique combination of cardiothoracic and cardiovascular anatomy. It also emphasizes the importance of radiologists in caring for patients with laterality defects. As these disorders are uncommon, more data on their anatomic variations may help provide better medical care to this patient population.

Heterotaxy polysplenia syndrome presenting with bleeding from the greater curvature of stomach: a case report

Background

The “heterotaxy syndrome” also called “situs ambiguus” is a rare condition in which the internal organs of the chest and abdomen are abnormally arranged. This syndrome is usually associated with a spectrum of health-related conditions involving birth defects in organs like the heart, spleen, liver, lungs and others.

Case presentation

We present a case of a 29-year-old male who came with an episode of massive upper gastrointestinal bleeding. On arrival he was vitally unstable and after resuscitation underwent a contrast-enhanced CT scan examination. The CT scan identified the features of heterotaxy syndrome with left isomerism and an abnormal blush from the branch of splenic artery supplying the greater curvature of the stomach. Embolization of the splenic artery branches was performed with the help of gel foam. No abnormal blush was identified post-embolization. Later on, in his hospital stay the patient went into pulse less electrical activity and died.

Conclusion

Upper gastrointestinal bleed in the patients with heterotaxy syndrome is a rare presentation of a rare condition. Our case highlights the importance of diagnostic and interventional radiology in diagnosing such patients and identifying the site of bleed especially where endoscopic visualization is not possible and managing the bleeding efficiently.

Incidental Finding of Heterotaxy Syndrome in a Patient With Pulmonary Embolism: A Case Report and Concise Review

Heterotaxy syndrome, also called atrial isomerism, is a rare congenital condition in which the internal organs are abnormally arranged across the left-right axis of the body. It is classified into polysplenia syndrome or left atrial isomerism and asplenia syndrome or right atrial isomerism. It is associated with high morbidity and mortality due to the severity of cardiac anomalies. It is important to be aware of the syndrome findings as they can be incidentally found on imaging in adults. Here, we report a case of a 33-year-old female who presented with worsening shortness of breath, found to have a pulmonary embolism, and heterotaxy was incidentally identified on her imaging. A concise review follows.

Heterotaxy polysplenia syndrome in an adult female with complete endocardial cushion defect

Heterotaxy syndrome is a rare condition characterized by the abnormal arrangement of thoracoabdominal organs across the left-right axis of the body.

It is generally classified as right and left atrial isomerism or asplenia and polysplenia syndrome, even though there are overlaps and uncertainties. The diagnosis of isomerism is typically made by echocardiography. However, multidetector computed tomography and MRI can help in obtaining detailed data on the morphology of the heart, great vessels, the anatomy of the internal organs, and their mutual arrangement that make an accurate diagnosis of heterotaxy syndrome.

The authors present here the imaging findings of the heterotaxy polysplenia syndrome in a 21-year-old female with a complete endocardia cushion defect and a duplicated right renal vein.