An Incidental Diagnosis of Dextrocardia on Chest X-ray during routine Evaluation in Post-op Resection of Acoustic Neuroma Patient

A 60-year-old male patient with a history of dizziness, frontal headache, and diabetic imbalances was admitted to the Neurology Outpatient Department. He had a history of bronchial asthma, kharra, tobacco chewing, and alcohol consumption. Due to his medical history, he experienced a convulsion, tongue injury, and a convulsion in the Neurosurgery ward. He was transferred to the NeuroICU and required intubation via tracheostomy. A physiotherapy regimen was initiated to address his condition and aid in his recovery. The patient presented with tachypnea and tachycardia, elevated respiratory and heart rate, and a Glasgow Coma Scale (GCS) of E3VTM4. He had sluggish bilateral pupillary light reflex and a cough reflex. Cranial nerve assessments revealed impairments in cranial nerves 5, 6, 7, and 8, affecting mastication, lateral rectus movement, facial expressions, and auditory acuity. Corneal reflex was graded as diminished. Neurological examinations revealed reduced biceps and ankle jerk, absence of plantar response, and decreased muscle tone in the right upper limb. The patient was mechanically ventilated via tracheostomy in SIMV mode due to aspiration as a consequence of tongue injury. Arterial blood gas (ABG) analysis revealed the presence of uncompensated respiratory acidosis. The audiogram exhibited moderately severe mixed hearing loss in the right ear and severe mixed hearing loss in the left ear. Postoperative head computed tomography (CT) demonstrated a calvarial defect on the left occipital bone, accompanied by an underlying mixed-density collection and multiple large air collections along the left cerebellopontine angle cistern. Additionally, the left tentorium exhibited overlying extracalvarial soft tissue swelling, consistent with postoperative changes. Several air foci were observed along the anterior falx and in the right temporal region. Routine investigation through chest X-ray, performed for the evaluation of lung fields due to the patient's tongue bite incident, revealed the presence of the heart on the right side and a heterogeneous opacity on the right side.

Keywords: Calvarial defect, Audiogram, Anterior falx, Heterogenous opacity, Dextrocardia