The authors reported a 73-year-old alcoholic man with previously-unrecognized 
situs inversus totalis suffering from left upper quadrant pain. Acute myocardial 
infarction was diagnosed and coronary angioplasty was performed immediately. 
However, the massive bleeding from the previously-unfound hepatomas caused 
hypovolemic shock and fatal outcome. Situs inversus totalis is a rare congenital 
anomaly with a complete mirror image of the thoracic and abdominal organs. 
Although being considered a benign entity, it would disturb diagnosis-making of 
the visceral diseases owing to the altered anatomy. To our knowledge, the 
coexistence of the coronary artery disease and ruptured hepatomas in situs 
inversus totalis, as in our patient, is never described. Recognition of any 
situs anomalies in time is the key to avoid misdiagnosis, inappropriate 
managements, and unwanted consequences.