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Weekly Chest CasesArchive of Old Cases

Case No : 625 Date 2009-10-18

  • Courtesy of Chang Hyun Lee / Seoul National University Hospital
  • Age/Sex 53 / F
  • Chief ComplaintChronic cough and sputum
  • Figure 1

Diagnosis With Brief Discussion

Diagnosis
Kartagener's syndrome (Immotile ciliary sydrome)
Radiologic Findings
Chest PA shows multifocal cystic bronchiectasis and dextrocardia. Stomach gas is seen in the right side suggesting situs inversus. Chest CT confirms cystic bronchiectasis and situs inversus. PNS view reveals sinusitis showing haziness in both maxillary sinuses.
Brief Review
Kartagener's Syndrome is a chronic lung disease that occurs when cilia are unable to move. Kartagener's Syndrome is a rare genetic birth defect. Individuals with Kartagener's Syndrome have abnormal or absent ciliary motion. Kartagener's Syndrome is also called Primary Ciliary Dyskinesia, and Immotile Cilia Syndrome, Afzelius’ syndrome, Kartagener’s triad, Zivert's syndrome, and Zivert-Kartagener triad. Cilia are tiny hair-like structures that are present on the surfaces of many different types of cells. One of the functions of cilia is to move mucus out of the respiratory passages. During infections more mucus is produced and because the abnormal cilia can't move or move ineffectively, mucus becomes stuck and blocks the respiratory tract, causing various complications.

Some common symptoms of Kartagener's syndrome are chronic rhinitis, recurrent or chronic sinusitis, recurrent or chronic bronchitis, bronchiectasis, olfactory impairment, and infertility.
Treatment is aimed at reducing symptoms and slowing disease progression. Complications of Kartagener's Syndrome include
bronchiectasis, difficulty breasthing, and chronic wheezing and coughing. Bronchiectasis occurs when the bronchial tubes are blocked and chronically infected, causing the tubes to weaken and stretch out. The widened tubes allow more mucus and bacteria to accumulate, leading to infection and possibly pneumonia.

References
1. Nadel HR, Stringer DA, Turner JA, Sturgess JM. The immotile cilia syndrome: radiological manifestations. Radiology. 1985;154:651-5.
2. High-Resolution CT of patients with primary ciliary dyskinesia. AJR. 2007;188:1232-8.
Keywords
Lung, Airway, Congenital, Bronchiectasis, Genetic disorder,

No. of Applicants : 130

▶ Correct Answer : 111/130,  85.4%
  • - NTUH , Taiwan Kuei-pin Chung
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
  • - Osaka University , Japan Osamu Honda
  • - Assam medical college , India Karunakaran M
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - SMG-SNUH boramae medical center , Korea (South) Kwang Nam Jin
  • - SMC , Korea (South) Jihoon Cha
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - EKH-Berlin , Germany Michael Weber
  • - KING KHALID UNIVERSITY HOSPITAL RADIOLOGY DEPARTMENT , Saudi Arabia elbagir nasser
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - hospital Sao Paulo , Brazil israel missrie
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Saga University , Japan Ryoko Egashira
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - Chungnam national university hospital , Korea (South) Jeoung Eun Lee
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India , India Bankim Amin
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - KMC,Manipal , India satish maddukuri
  • - Ruby Hall Clinic , India john joseph
  • - Teleradiology solutions , India harish bhambore
  • - Busan Paik hospital, Inje university , Korea (South) Hye Jin Baek
  • - Radiologie Centrale CHU Saint Etienne , France Romain MALEZIEUX
  • - Apollo Gleneagles hosp kolkata , India SALIM PARVEZ
  • - barnard institute of radiology , India jithika prem
  • - Paramount Diagnostic & Research Centre , India Mahavir Swami
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Seoul National University Hospital , Korea (South) Hye Jin Yoo
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - CHR LILLE, France , France Vittorio Pansini
  • - vinayaka missions medical college , India k bhaskar
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - CHU caen , France nicolas gautier
  • - Assam Medical College , India Pramod K.G
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - CHRU Lille , France guillaume lefebvre
  • - CHU Nancy , France, Metropolitan Guillaume LUX
  • - NATIONAL HOSPITALS , United Arab Emirates ABDUL RESHI
  • - ROHINI Scan Centre RSC. Ambattur, Chennai , India Umapathi Mahesh
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - CH Macon , France sebastien LARIVE
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - Cairo University , Egypt Mamdouh Eissa
  • - CHRU Lille , France Benjamin Damarey
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Dong-A university hospital , Korea (South) Sang-yun LEE
  • - MD SKNMC & GH,Pune,Maharashtra, INDIA , India Sushant Bhadane
  • - partner, aditya imaging centre , India vivek patel
  • - Barnard Institute of Radiology , India Bhuvaneswaran Natarajan
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Soonchunhyang university hospital, Bucheon , Korea (South) ALEUM LEE
  • - Pneumology GHSR , Reunion fabrice paganin
  • - institute of chest diseases calicut , India divya nair
  • - CH Sud Rnion , Reunion jean-baptiste Noel
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
  • - Yashoda Superspeciality hospital , India Pravin Mahadevappa
  • - Samsun Medical park hospital , Turkey Adem Dirican
  • - Seoul St Mary , Korea (South) Jin Kyoung Oh
  • - jiangsu province hospital , China yuan doctor
  • - Mackay Memorial Hospital , Taiwan Sheng-Yeh Shen
  • - Goa Medical College , India Paresh Desai
  • - severance hospital , Korea (South) Lee Kyung Jong
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - KKUH , Saudi Arabia raees ahmed
  • - chp st martin , France Mariotte benoit
  • - sunder lal jain hospital , India sanjeev vachher
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - KING KHALID HOSPITAL , Saudi Arabia medhat eid
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - CHRU lille , France manuel toledano
  • - All India Institute of medical sciences , India Justin Moses
  • - ASSAM MEDICAL COLLEGE , India joe jose
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Trakya University School of Medicine Department of Radiology , Turkey Devrim Urut
  • - Trakya University Medical Faculty Department of Radiology , Turkey AslMENTES
  • - Hital SacrCoeur, Montrl , Canada Andrea Ojanguren
  • - IRSA , France jean-luc BIGOT
  • - Gangnam Severance Hospital , Korea (South) Min Jeong Kim
  • - DCA, , India Rajesh Gothi
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Yashoda hospitals , India kirti parsi
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PRIVATE PRACTITIONER , India BALA SWAMY
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chae Lim
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - KING KHALID UNIVERSITY HOSPITAL,RIYADH , Saudi Arabia NABIL GHALEB
  • - hospital 12 de octubre , Spain sergio alonso
  • - CSSS LAVAL , Canada olivier krief
  • - , Korea (South) Daekeon Lim
▶ Correct Answer as Differential Diagnosis : 1/130,  0.8%
  • - care hospital , India Chary D
▶ Semi-Correct Answer : 10/130,  7.7%
  • - NMC hospital Dubai , United Arab Emirates vickrant malhotra
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - aarthi scans , India abirami mahadevan
  • - Catholic medical center , Korea (South) HyunA Kim
  • - skmc , United Arab Emirates ahmed rabiea
  • - assam medical college and hospital , India gorky medhi
  • - clinique de rochefort , France viviane pages
  • - Gangnam severance hospital , Korea (South) Sejin Nam
  • - Trakya University School of Medicine, Edirne , Turkey Ahmet POLAT
  • - McGill University Health Center , Canada Alexandre Semionov
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