Daily Radiology Case

Explanation

The CT demonstrates dextrocardia as part of complete situs inversus, where all thoracic and abdominal organs are mirrored, alongside cylindrical bronchiectasis of the lower lobes reflecting chronic suppurative airway disease from impaired mucociliary clearance. This results from a primary ciliary dyskinesia. An autosomal recessive defect in dynein arm structure that renders cilia nonfunctional throughout the body. When situs inversus co-occurs with bronchiectasis and chronic sinusitis, it defines Kartagener syndrome, a subset of primary ciliary dyskinesia that also causes male infertility due to immotile sperm.

Source: Haouimi A, Kartagener syndrome. Case study, Radiopaedia.org (Accessed on 23 Apr 2026) https://doi.org/10.53347/rID-234001

Hints

• 25-year-old male presents with a lifelong history of recurrent chest infections and chronic nasal congestion, prompting a CT chest to evaluate for structural pulmonary pathology.
• On examination, his cardiac impulse is palpable on the right side of the chest, and auscultation confirms heart sounds are loudest at the right sternal border.
• He reports that his symptoms began in childhood, and his parents recall he had frequent ear infections and episodes of pneumonia growing up; he also notes he has never been able to father children despite trying.
• CT chest shows the cardiac silhouette positioned entirely within the right hemithorax with a mirror-image arrangement of the great vessels, consistent with true dextrocardia.
• Additionally, the CT demonstrates cylindrical bronchiectasis predominantly involving the lower lobes bilaterally, with characteristic bronchial wall thickening reflecting chronic airway injury from recurrent infection.
• This condition results from a hereditary defect in the ultrastructural components responsible for directional cellular motility, causing impaired mucociliary clearance throughout the respiratory tract, abnormal laterality determination during embryogenesis, and male infertility.