Presentation
Chronic sinusitis since childhood, routine check-up.
Patient Data
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CXR demonstrates situs inversus (right sided heart, aorta and stomach bubble). Striking bilateral peribronchial cuffing and dilated bronchial tree, mainly in upper and lower lobe on the left side.
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CT confirms situs inversus (mirror image of thoracic and upper abdominal content). The lung window setting the varicose to cystic bronchiectasis is well demonstrated. Also, the tree-in-bud sign is well visible in both lower lobes suggests current endobronchial infection.
Case Discussion
Kartagener syndrome is an autosomal recessive hereditary disease and a combination of findings that are also described with the immotile cilia syndrome (also called primary ciliary dyskinesia). The syndrome typically presents with:
- situs inversus
- bronchiectasis
- chronic sinusitis
- infertility in males
The tree-in-bud sign is often associated with Kartagener Syndrome, indicative of obstructive bronchiolitis. Impaction of mucoid material is a typical finding in these patients.
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