CXR Case 002

44 yo man has routine CXR after possible faint

Top 100 CXR LITFL 002

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is dextrocardia.

The stomach gas bubble is also on the right side, suggesting situs inversus*

There are coarse, thickened bronchial markings and small ring shadows, most notable in the upper lobes, consistent with bronchiectasis


CLINICAL IMPLICATIONS

Kartagener syndrome describes Primary Ciliary Dyskinesia (PCD), bronchiectasis and situs invertus.

*Other features include chronic sinusitis, infertility*

Diagnosis of PCD is with nasal brushings and biopsy to assess ciliary beat frequency with video microscopy; a poor man’s test is with the saccharin test – time for saccharin to be tasted in the mouth after deposition of droplet of saccharin on the inferior turbinate of the nose.


CLINICAL PEARLS

About 30% of those with PCD will have situs inversus with, or without, dextrocardia as the cilia determine the side of the organs. 

Random organ siting occurs, hence the situs inversus.


TOP 150 CXR SERIES

    


Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar |

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