Answer of February 2007

Clinical History:

A 34-years-old lady whom had a history of recurrent sinusitis, presented with shortness of breath. HRCT of the thorax was obtained.

Diagnosis:

Kartagener syndrome

Discussion:

HRCT thorax showed mirror-image arrangement of situs solitus.  The systemic atrium is on the left side with a left-sided trilobed lung, liver, gallbladder, and inferior vena cava.  The pulmonary atrium is on the right with a right-sided bilobed lung, stomach, single spleen and aorta.  Left-sided aortic arch and superior vena cava are seen with the pulmonary trunk situating on right side.  Dextrocardia is evident with the cardiac apex located on the right side.  Findings are compatible with situs inversus totalis. 

Dilated thick-walled bronchioles are seen at bilateral lower lobes showing non-tapered ends and signet-ring appearance, compatible with bronchiectasis.  Together with history of recurrent sinusitis, overall features are in keeping with Kartagener syndrome.