A 9-year-old male with no relevant past medical history was admitted to the emergency department with intermittent chest pain of 1 month duration associated with an abnormal electrocardiogram (ECG): QRS axis attenuation and T wave inversion
No episodes of syncope were reported.
Physical examination showed a good general appearance, remaining hemodynamically stable, highlighting pain at the left thoracic muscle level, which increased with inspiration and mobilization of upper limbs.
Cardiac auscultation revealed increased heart sounds in the right precordial area and attenuated in the left.
Given the time of evolution of the pain and the referred electrocardiographic alteration, ECG was repeated, persisting QRS axis and P wave of +150°, narrow QRS voltage attenuated in precordial leads V3-V6 and on
The chest X-ray confirmed the presence of dextran; additionally, a gastric bubble was observed in the left hepatic lobe and so the situs was confirmed in the abdominal ultrasound.
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The patient was admitted to the Pediatric Cardiology Ward where echocardiography was performed, establishing classic dextro specularism without associated cardiac malformations.
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Due to suspicion of musculoskeletal etiology, chest pain was treated with progressive improvement, and the patient was asymptomatic at the time of follow-up.
