Saturday, June 27, 2015

Tin Man Syndrome - RadioPaedia X-ray and CT scan of Ectopia cordis interna : Age of Tin Man

There was a chest extra doing the rounds that showed no visible heart shadow. Here it is :

AP Chest Radiograph of Tin Man Syndrome

It was posted by Radiopaedia, the radiologist community website in April 2015. They even had lateral view X-ray and also had a CT scan of the abdomen to show that the heart was actually located in the abdomen.

Lateral view - chest X ray of Tin Man Syndrome
 Frontal and lateral chest radiographs demonstrating absent cardiomediastinal outline. No aortic outline is evident. Bilateral ectopic inferior pulmonary veins.

CT scan showing ectopic location of heart

Case Discussion:

Ectopia cordis interna, also known as Tin Man syndrome, is a rare variant form of ectopia cordis in which the heart is located completely within the abdominal cavity. It is almost always an asymptomatic condition found incidentally on imaging, or less often detected by physicians when attempting to auscultate the chest or at abdominal palpation. 
There remains debate as to whether Leonardo Da Vinci's "Organ networks of the thoracoabdominal cavity" illustration (c.1502) was based off a corpse with ectopia cordis interna, or whether his depiction of the heart's location was a deliberate distortion of reality. Most legitimate scholars believe Da Vinci created the work as a flight of anatomical fancy.           
The first ever description of the condition in the medical literature was in a controversial monographsubmitted to the Royal Society in 1874 by Dr. Nohear Lubdub. Entitled "An unusual case of ectopia cardia epigasticum in a Haryana boy", the monograph was later retracted when accusations were made that the images accompanying the text had been doctored.
It was not until 1908 that Dr Lubdub's work was vindicated when existence of the condition was confirmed during the early years of chest radiography. Unfortunately, Dr Lubdub had fallen into a deep depression following his expulsion from the Royal Society, only occasionally seen wandering the streets of Chandigarh mumbling "and yet it beats". His death was unrecorded. 

All these were just part of an elaborate April fools prank which Radiopaedia makes sure to do every April fools since 2012.

Why is it called Tin Man Syndrome ?

It is called Tin Man Syndrome because of the Tin Man in "The Wizard of Oz", who had no heart.

List of April fools cases 

Watch this video for an Intro to Tin Man - Avengers Age of Ultron Mashup

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