Traumatic tension pneumothorax causing heart rotation
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A 48-year-old man was referred to the emergency department for chest trauma related to a motorcycle accident.The findings on cardiac auscultation and electrocardiography were consistent with possible dextrocardia. A chest radiograph and computed tomographic (CT) scan showed a 90-degree rightward rotation of the cardiac silhouette (Panel A, arrow) and great vessels (Panel C, arrows) with left tension pneumothorax and multiple rib fractures, bilateral pulmonary contusion and ruptured spleen. A total-body CT scan showed rightward rotation of the pulmonary artery and aorta (Panel C), rotation of both atria and rotation of both ventricles.The mediastinal shift that was caused by the tension pneumothorax caused mild circulatory instability without neurologic impairment. The patient underwent emergency spleen removal and left pleural drainage...

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