Fabrice Cuillier, MD*; J. P. Bourdil, MD**; P. Lemaire, MD***; P. Deshayes, MD***; Alice Bertha****.

*     Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France;
**    Obstetrician, Quartier du Chaudron, 97400 Saint-Denis, Ile de la Réunion, France;
***   Echographist, Moufia’street, 97400 Saint-Denis, Ile de la Réunion, France;
****  Student, Arizona State University. University Drive and Mill Avenue Tempe, Arizona 85281.

This is a 30-year-old woman (G3P2), referred to our antenatal unit at 34 weeks of gestation, due to a visceral situs inversus of the fetus, without cardiac malposition or malformation. The fetus was in cephalic position. Morphologically normal heart was on the left side, while stomach was situated on the right side. The liver was on the left side and the gallbladder was located laterally to the umbilical vein on the right side. Fetal echocardiography showed situs solitus of the atria, ventricles and great arteries. The atrioventricular concordance was normal, and so was the ventriculoarterial connection. The pulmonary veins emptied to the left atrium.
The superior vena cava was connected to the right atrium, but the inferior vena cava could not be seen. Near the aorta, on the right, a vessel situated posterior to the aorta was seen, representing an azygos vein continuation of the inferior vena cava. We presumed the diagnosis of the inferior vena cava interruption with azygous continuation. No other anomalies were seen. Amniocentesis was performed and showed normal karyotype.
The fetus was delivered at 39 weeks. The prenatal findings were confirmed and the mother and the baby were discharged at fifth day after delivery.

Postnatal sonography revealed a right-sided stomach, a normal spleen (on the right side) and a left-sided liver. The kidneys were normal. The gallbladder was located in the midline. The echocardiography confirmed the normal heart without any intracardiac abnormalities.

Four months after delivery the baby is developing well without any problems.

Images 1, 2:  34th week of pregnancy. Image 1 shows a transverse abdominal plane with the stomach on the right side (S), aorta in front of the spine (Ao) and vena azygous running behind the aorta on the right side (Va). Image 2 shows a transverse plane of the thorax at the level of four-chamber view. The heart is oriented to the left side (levocardia) with normal morphology. Little markers point to the pulmonary veins emptying to the left atrium. Aorta (Ao) and vena azygous continuation (Va) are visible behind the heart.

Images 3, 4: 34th week of pregnancy. Image 3 shows a series of abdominal and thoracic transverse planes comparing the position of the heart (levocardia) and abdominal organs (visceral situs inversus). Image 4 shows normal outflow tracts of the heart.

Images 5, 6:  34th week of pregnancy. Image 5 shows a transverse plane of the thorax at the level of four-chamber view. Using the color Doppler, the aorta and vena azygous continuation are visible behind the heart. Image 6 shows upper transverse thoracic view with the superior vena cava, aorta and pulmonary artery (AP) with its division on the left and right branches.

Images 7, 8:  34th week of pregnancy. Sagittal gray scale (image 7) and color Doppler (image 8) scans showing the continuation of the vena azygous to the superior vena cava.

Video 1: 34th week of pregnancy. Video shows sagittal plane of the thorax - aorta and continuation of the vena azygous to the superior vena cava are visible in parallel behind the heart.