presentation1, radiological imaging of karrtegner,s syndrome
TRANSCRIPT
Radiological imaging of Kartagener syndrome
Dr ABD ALLAH NAZEER MD
Kartagener syndrome is a subset of primary ciliary dyskinesia an autosomal recessive condition characterized by abnormal ciliary structure andor function leading to impaired mucociliary clearanceEpidemiologyThe prevalence of primary ciliary dyskinesia is approximately 1 in 12000-60000 Approximately 50 of patient with primary ciliary dyskinesia have Kartagener syndrome situs abnormality No gender predilection is recognizedClinical presentationKartagener syndrome is characterized by the clinical triad ofsitus inversuschronic sinusitis andor nasal polyposisbronchiectasisOther features includetelecanthus widened interpupillary distance by a nasal polypinfertility in malessubfertility in females
Other associationsTransposition of great vesselsTrilocular or bilocular heartPyloric stenosisPostcricoid webMarfanrsquos syndromePolyspleniaHepatic steatosisHydrocephalusUsherrsquos syndrome
DeafnessVestibular dysfunctionRetinitis pigmentosa
All have ciliary dyskinesia in common
Incidence112500-40000Autosomal recessive inheritance
Ciliary dyskinesia can also be acquiredSmokers most commonly
Plain radiographChest radiographic findings depend on the severity of underlying bronchiectasis Findings may include bronchial wall thickening bronchial dilatation with loss of normal peripheral taperingpredilection to involve the right middle lingular segment of the left upper lobe and the lower lobesmucus plugs maybe visible finger in glove signconsolidationsitus abnormality ie situs inversus
UltrasonographyEchocardiography demonstrates the morphologic left and right atria The morphologic right atrium has connections to the superior and inferior vena cava and a wide atrial appendage The morphologic left atrium has a narrow left atrial appendage Ultrasonography demonstrates the mirror-image anatomy of the abdominal viscera Fetal Ultrasonography can be used to detect situs inversus in utero detection of this condition in utero alerts the physician to the possibility of congenital heart disease which then warrants a careful cardiac evaluation
CTCT tends to demonstrate bronchiectasis which may be variable in severity However changes are much milder than in cystic fibrosis The morphology of bronchiectasis can be tubularcylindrical or saccularcysticIn addition CT demonstratesconsolidationmucocele impacted mucus in bronchiolestree-in-bud pattern or centrilobular nodules maybe encountered with mucus impaction and endobronchial spread of infectionmosaic perfusion air trapping as ancillary findingseventual scarring may result from recurrent infection requiring pulmonary resection surgery Angiography is unnecessary for the diagnosis of situs inversus In fact noninvasive methods are preferred Although the atrial morphology can be analyzed to determine atrial situs angiography is usually reserved for the evaluation of congenital heart disease
Magnetic Resonance ImagingMRI is a valuable adjunct to echocardiography and angiography in demonstrating abnormalities of congenital heart disease and in aiding surgical planning This imaging modality is particularly helpful in diagnosing atrial situs The morphologic right atrium contains the ostium of the coronary sinus a connection to the suprahepatic inferior vena cava a large wide-based pyramidal atrial appendage the crista terminalis and the pectinate muscles The morphologic left atrium has the ostia for the pulmonary veins and an atrial appendage with a narrow base and a tubular hooked shape
Nuclear ImagingAny nuclear medicine study that is used to evaluate the heart or viscera can be influenced by the presence of situs inversus These studies include cardiac pulmonary hepatobiliary splenic and gastrointestinal imaging For example on a ventilation-perfusion pulmonary scan the photopenic defect from the heart is reversed in cases of situs inversus with dextrocardia The technologist must be able to recognize situs inversus anatomy because nonstandard camera positioning is often necessary for optimal imaging
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartagener syndrome is a subset of primary ciliary dyskinesia an autosomal recessive condition characterized by abnormal ciliary structure andor function leading to impaired mucociliary clearanceEpidemiologyThe prevalence of primary ciliary dyskinesia is approximately 1 in 12000-60000 Approximately 50 of patient with primary ciliary dyskinesia have Kartagener syndrome situs abnormality No gender predilection is recognizedClinical presentationKartagener syndrome is characterized by the clinical triad ofsitus inversuschronic sinusitis andor nasal polyposisbronchiectasisOther features includetelecanthus widened interpupillary distance by a nasal polypinfertility in malessubfertility in females
Other associationsTransposition of great vesselsTrilocular or bilocular heartPyloric stenosisPostcricoid webMarfanrsquos syndromePolyspleniaHepatic steatosisHydrocephalusUsherrsquos syndrome
DeafnessVestibular dysfunctionRetinitis pigmentosa
All have ciliary dyskinesia in common
Incidence112500-40000Autosomal recessive inheritance
Ciliary dyskinesia can also be acquiredSmokers most commonly
Plain radiographChest radiographic findings depend on the severity of underlying bronchiectasis Findings may include bronchial wall thickening bronchial dilatation with loss of normal peripheral taperingpredilection to involve the right middle lingular segment of the left upper lobe and the lower lobesmucus plugs maybe visible finger in glove signconsolidationsitus abnormality ie situs inversus
UltrasonographyEchocardiography demonstrates the morphologic left and right atria The morphologic right atrium has connections to the superior and inferior vena cava and a wide atrial appendage The morphologic left atrium has a narrow left atrial appendage Ultrasonography demonstrates the mirror-image anatomy of the abdominal viscera Fetal Ultrasonography can be used to detect situs inversus in utero detection of this condition in utero alerts the physician to the possibility of congenital heart disease which then warrants a careful cardiac evaluation
CTCT tends to demonstrate bronchiectasis which may be variable in severity However changes are much milder than in cystic fibrosis The morphology of bronchiectasis can be tubularcylindrical or saccularcysticIn addition CT demonstratesconsolidationmucocele impacted mucus in bronchiolestree-in-bud pattern or centrilobular nodules maybe encountered with mucus impaction and endobronchial spread of infectionmosaic perfusion air trapping as ancillary findingseventual scarring may result from recurrent infection requiring pulmonary resection surgery Angiography is unnecessary for the diagnosis of situs inversus In fact noninvasive methods are preferred Although the atrial morphology can be analyzed to determine atrial situs angiography is usually reserved for the evaluation of congenital heart disease
Magnetic Resonance ImagingMRI is a valuable adjunct to echocardiography and angiography in demonstrating abnormalities of congenital heart disease and in aiding surgical planning This imaging modality is particularly helpful in diagnosing atrial situs The morphologic right atrium contains the ostium of the coronary sinus a connection to the suprahepatic inferior vena cava a large wide-based pyramidal atrial appendage the crista terminalis and the pectinate muscles The morphologic left atrium has the ostia for the pulmonary veins and an atrial appendage with a narrow base and a tubular hooked shape
Nuclear ImagingAny nuclear medicine study that is used to evaluate the heart or viscera can be influenced by the presence of situs inversus These studies include cardiac pulmonary hepatobiliary splenic and gastrointestinal imaging For example on a ventilation-perfusion pulmonary scan the photopenic defect from the heart is reversed in cases of situs inversus with dextrocardia The technologist must be able to recognize situs inversus anatomy because nonstandard camera positioning is often necessary for optimal imaging
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Other associationsTransposition of great vesselsTrilocular or bilocular heartPyloric stenosisPostcricoid webMarfanrsquos syndromePolyspleniaHepatic steatosisHydrocephalusUsherrsquos syndrome
DeafnessVestibular dysfunctionRetinitis pigmentosa
All have ciliary dyskinesia in common
Incidence112500-40000Autosomal recessive inheritance
Ciliary dyskinesia can also be acquiredSmokers most commonly
Plain radiographChest radiographic findings depend on the severity of underlying bronchiectasis Findings may include bronchial wall thickening bronchial dilatation with loss of normal peripheral taperingpredilection to involve the right middle lingular segment of the left upper lobe and the lower lobesmucus plugs maybe visible finger in glove signconsolidationsitus abnormality ie situs inversus
UltrasonographyEchocardiography demonstrates the morphologic left and right atria The morphologic right atrium has connections to the superior and inferior vena cava and a wide atrial appendage The morphologic left atrium has a narrow left atrial appendage Ultrasonography demonstrates the mirror-image anatomy of the abdominal viscera Fetal Ultrasonography can be used to detect situs inversus in utero detection of this condition in utero alerts the physician to the possibility of congenital heart disease which then warrants a careful cardiac evaluation
CTCT tends to demonstrate bronchiectasis which may be variable in severity However changes are much milder than in cystic fibrosis The morphology of bronchiectasis can be tubularcylindrical or saccularcysticIn addition CT demonstratesconsolidationmucocele impacted mucus in bronchiolestree-in-bud pattern or centrilobular nodules maybe encountered with mucus impaction and endobronchial spread of infectionmosaic perfusion air trapping as ancillary findingseventual scarring may result from recurrent infection requiring pulmonary resection surgery Angiography is unnecessary for the diagnosis of situs inversus In fact noninvasive methods are preferred Although the atrial morphology can be analyzed to determine atrial situs angiography is usually reserved for the evaluation of congenital heart disease
Magnetic Resonance ImagingMRI is a valuable adjunct to echocardiography and angiography in demonstrating abnormalities of congenital heart disease and in aiding surgical planning This imaging modality is particularly helpful in diagnosing atrial situs The morphologic right atrium contains the ostium of the coronary sinus a connection to the suprahepatic inferior vena cava a large wide-based pyramidal atrial appendage the crista terminalis and the pectinate muscles The morphologic left atrium has the ostia for the pulmonary veins and an atrial appendage with a narrow base and a tubular hooked shape
Nuclear ImagingAny nuclear medicine study that is used to evaluate the heart or viscera can be influenced by the presence of situs inversus These studies include cardiac pulmonary hepatobiliary splenic and gastrointestinal imaging For example on a ventilation-perfusion pulmonary scan the photopenic defect from the heart is reversed in cases of situs inversus with dextrocardia The technologist must be able to recognize situs inversus anatomy because nonstandard camera positioning is often necessary for optimal imaging
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Plain radiographChest radiographic findings depend on the severity of underlying bronchiectasis Findings may include bronchial wall thickening bronchial dilatation with loss of normal peripheral taperingpredilection to involve the right middle lingular segment of the left upper lobe and the lower lobesmucus plugs maybe visible finger in glove signconsolidationsitus abnormality ie situs inversus
UltrasonographyEchocardiography demonstrates the morphologic left and right atria The morphologic right atrium has connections to the superior and inferior vena cava and a wide atrial appendage The morphologic left atrium has a narrow left atrial appendage Ultrasonography demonstrates the mirror-image anatomy of the abdominal viscera Fetal Ultrasonography can be used to detect situs inversus in utero detection of this condition in utero alerts the physician to the possibility of congenital heart disease which then warrants a careful cardiac evaluation
CTCT tends to demonstrate bronchiectasis which may be variable in severity However changes are much milder than in cystic fibrosis The morphology of bronchiectasis can be tubularcylindrical or saccularcysticIn addition CT demonstratesconsolidationmucocele impacted mucus in bronchiolestree-in-bud pattern or centrilobular nodules maybe encountered with mucus impaction and endobronchial spread of infectionmosaic perfusion air trapping as ancillary findingseventual scarring may result from recurrent infection requiring pulmonary resection surgery Angiography is unnecessary for the diagnosis of situs inversus In fact noninvasive methods are preferred Although the atrial morphology can be analyzed to determine atrial situs angiography is usually reserved for the evaluation of congenital heart disease
Magnetic Resonance ImagingMRI is a valuable adjunct to echocardiography and angiography in demonstrating abnormalities of congenital heart disease and in aiding surgical planning This imaging modality is particularly helpful in diagnosing atrial situs The morphologic right atrium contains the ostium of the coronary sinus a connection to the suprahepatic inferior vena cava a large wide-based pyramidal atrial appendage the crista terminalis and the pectinate muscles The morphologic left atrium has the ostia for the pulmonary veins and an atrial appendage with a narrow base and a tubular hooked shape
Nuclear ImagingAny nuclear medicine study that is used to evaluate the heart or viscera can be influenced by the presence of situs inversus These studies include cardiac pulmonary hepatobiliary splenic and gastrointestinal imaging For example on a ventilation-perfusion pulmonary scan the photopenic defect from the heart is reversed in cases of situs inversus with dextrocardia The technologist must be able to recognize situs inversus anatomy because nonstandard camera positioning is often necessary for optimal imaging
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
CTCT tends to demonstrate bronchiectasis which may be variable in severity However changes are much milder than in cystic fibrosis The morphology of bronchiectasis can be tubularcylindrical or saccularcysticIn addition CT demonstratesconsolidationmucocele impacted mucus in bronchiolestree-in-bud pattern or centrilobular nodules maybe encountered with mucus impaction and endobronchial spread of infectionmosaic perfusion air trapping as ancillary findingseventual scarring may result from recurrent infection requiring pulmonary resection surgery Angiography is unnecessary for the diagnosis of situs inversus In fact noninvasive methods are preferred Although the atrial morphology can be analyzed to determine atrial situs angiography is usually reserved for the evaluation of congenital heart disease
Magnetic Resonance ImagingMRI is a valuable adjunct to echocardiography and angiography in demonstrating abnormalities of congenital heart disease and in aiding surgical planning This imaging modality is particularly helpful in diagnosing atrial situs The morphologic right atrium contains the ostium of the coronary sinus a connection to the suprahepatic inferior vena cava a large wide-based pyramidal atrial appendage the crista terminalis and the pectinate muscles The morphologic left atrium has the ostia for the pulmonary veins and an atrial appendage with a narrow base and a tubular hooked shape
Nuclear ImagingAny nuclear medicine study that is used to evaluate the heart or viscera can be influenced by the presence of situs inversus These studies include cardiac pulmonary hepatobiliary splenic and gastrointestinal imaging For example on a ventilation-perfusion pulmonary scan the photopenic defect from the heart is reversed in cases of situs inversus with dextrocardia The technologist must be able to recognize situs inversus anatomy because nonstandard camera positioning is often necessary for optimal imaging
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Magnetic Resonance ImagingMRI is a valuable adjunct to echocardiography and angiography in demonstrating abnormalities of congenital heart disease and in aiding surgical planning This imaging modality is particularly helpful in diagnosing atrial situs The morphologic right atrium contains the ostium of the coronary sinus a connection to the suprahepatic inferior vena cava a large wide-based pyramidal atrial appendage the crista terminalis and the pectinate muscles The morphologic left atrium has the ostia for the pulmonary veins and an atrial appendage with a narrow base and a tubular hooked shape
Nuclear ImagingAny nuclear medicine study that is used to evaluate the heart or viscera can be influenced by the presence of situs inversus These studies include cardiac pulmonary hepatobiliary splenic and gastrointestinal imaging For example on a ventilation-perfusion pulmonary scan the photopenic defect from the heart is reversed in cases of situs inversus with dextrocardia The technologist must be able to recognize situs inversus anatomy because nonstandard camera positioning is often necessary for optimal imaging
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Differential diagnosisSitus abnormality with associated lower lobe bronchiectasis should prompt the diagnosis of Kartagener syndrome However there is a differentialhereditary impaired mucociliary clearance
cystic fibrosisYoung syndrome
impaired immunityprimary immunodeficiency syndromeacquired immunodeficiency (AIDS)
hypersensitivity and immune reactionABPAgraft versus host disease
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
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
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartageners Syndrome
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
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
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartagenerrsquos syndrome The CT image on the left shows severe saccular bronchiectasis in the left lung (arrows) Note that the heart is on the right side ndash this is better appreciated on the CXR on which the bronchiectasis is also visible (arrows) The gastric air bubble is below the right hemidiaphragm therefore the patient has situs inversus
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Maxillofacial coronal CT image showing maxillary sinuses occupied by soft inflammatory tissue with hyperplasia of the mucosa covering the inferior turbinates
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
CT PNS showing chronic sinusitis
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartagener Syndrome CT image of the chest reveals multiple grape-like bronchiectasis in the lingula and in the right middle lobe
Kartagener Syndrome CT image of the lower chest shows inferior right lobe micronodularity with flowering-tree aspect especially in the postero-lateral segments of the lobe
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartageners syndrome
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartageners syndrome
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartageners syndrome
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartageners Syndrome with Situs Inversus on CXR and CT Scan
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Bronchiectasis + Situs Inversus on CT
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Computed tomography scan of the upper abdomen in a 40-year-old man with situs inversus and dextrocardia This image shows reversal of the normal anatomy The spleen (SP) stomach (ST) and liver (L) are shown The descending aorta (DA) is on the right
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Surgically corrected congenital heart disease and Kartagener syndrome
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Axial CT sections of chest in lung window show dextrocardia with dense cystic bronchiectasis involving middle lobe and lingula
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Frontal chest radiograph demonstrates dextrocardia (cardiac apex pointing to the right with right aortic arch - arrowheads) bibasilar coarse reticular opacities and loss of volumes in the lower lungs in a patient with Kartagener syndrome
Coronal reformatted CT image confirms the presence of extensive bibasilar bronchiectasis (arrows) and situs inversus Bronchiectasis in patients with this syndrome tends to involve the dependent parts of the lungs
Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
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Chest radiograph (A) shows reticular shadows associated with tramlines scattered nodular opacities in bilateral lung fields dextrocardia and right-sided gastric bubble Sinus X-ray (B) shows bilateral maxillary sinusitis and frontal sinus hypoplasia CT scan of chest (C and D) reveals cylindrical bronchiectasis mucus plugging and centrilobular nodules in bilateral lung fields and situs inversus totalis with stomach and spleen on the right liver on the left side and dextrocardia
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartagener syndrome
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Kartagener syndrome
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Transversal CT image (A) and transversal MRI HASTE (B) sequence of a 104-year-old boy with Kartagener syndrome The scans demonstrate an area of consolidation in the middle lobe
Thank You
Thank You