Situs inversus totalis: A mirror-image anatomy discovered incidentally on chest radiograph

Situs inversus totalis (SIT) is a rare congenital condition characterized by a complete mirror-image reversal of thoracic and abdominal organs. Although often asymptomatic and discovered incidentally, SIT poses significant challenges in clinical diagnosis, imaging interpretation, and surgical procedures. SIT is primarily caused by genetic variations, often inherited in an autosomal recessive pattern. An 18-year-old female presented for evaluation following complaints of mild, intermittent epigastric discomfort. A routine chest radiograph revealed dextrocardia, raising suspicion for situs inversus. Further imaging with abdominal ultrasonography confirmed transposition of visceral organs: The liver and gallbladder were in the left upper quadrant, while the stomach and spleen were visualized on the right side. This case emphasizes the importance of clinical suspicion and appropriate imaging in identifying SIT, especially in emergency and surgical settings. Awareness of such anatomical variations is critical to avoid misdiagnosis, especially in conditions such as appendicitis, myocardial infarction, or during laparoscopic procedures. SIT, while rare and often incidentally detected, has important clinical and surgical implications. Early recognition through imaging and careful documentation is essential to ensure accurate diagnosis and safe medical or surgical intervention.