MDOD

Fascinoma/Incidentaloma

An ‘incidentaloma’ is doctor-speak for a diagnosis made while looking for or ‘ruling out’ something else. In this case a young gentleman hopped up on oxycontin, marijuana, and alcohol got shivved in the gut. I can’t imagine why… he was nothing but nice to us.

I took this chest Xray to rule out free-air under the right hemidiaphragm which would have made a trip to the OR necessary. Using other means we made sure that this fine citizen had suffered nothing but a flesh wound.

This chest film demonstrates a very rare diagnosis, and rather than have all the other doctors tell you what it is I will tell you that it is dextrocardia. His heart is on the wrong side of his chest (just like in the prologue to SCRUBS but that film on the show is merely placed backwards on the light box).

Usually this is an error made by the XR tech who labels ‘left’ and ‘right’ mistakenly, but this is truly dextrocardia as the stomach bubble is where it should be… under the left hemidiaphragm. Also, the tech repeated the film because she thought she had mislabelled it the first time.

This is the second time I’ve seen this and it was of no clinical consequence either time. Whether folks with dextrocardia have a predisposition to being douchebag wastes of carbon is open for debate. It of course goes without saying that this young gentleman did not have a job, money, or insurance.

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