4 year, 1 month-old, Male, Beagle

History: Chronic signs of chronic rhinitis, chronic bronchitis with recurrent pneumonia. Recent onset of clinical signs suspicious for pneumonia

Images:

Findings :

The patient’s anatomic orientation is a mirror image of the typical presentation, with the cardiac apex, aortic arch, gastric fundus, splenic head, etc. on the right and the orientation of anatomic landmarks in the labeled right lateral projection typical for left lateral projections in patients with the typical anatomic orientation.  The pleural space and mediastinum are otherwise unremarkable. 

There is a moderate to severe, generalized bronchial pattern with a patchy interstitial component.  There is an alveolar pattern affecting the left middle lung lobe (assuming the lobar segmentation of this patient’s left lungs are similar to the right lungs in a normal animal) with left middle and left cranial lobar bronchiectasis (traction bronchiectasis from active pneumonia vs persistent long-standing bronchiectasis from chronic lower airway disease).

Cardiovascular structures are unremarkable.  No clearly relevant abnormalities are noted in the abdomen or included portions of the skeletal system aside from the anatomic variation.  There is some scant mineral debris in the stomach.

Radiographic Diagnosis :

The appearance of the “background” lung fields is consistent with the situs inversus totalis and ciliary dyskinesia (Kartagener syndrome) creating chronic bronchial disease with an active opportunistic bacterial lobar pneumonia in the left middle lung lobe, with likely developing disease in the left cranial lung lobe (versus residual effects of previous disease at this site).  The probability of other differentials of alveolar pattern such as pulmonary hemorrhage are considered very low in this setting.

4 comments

  1. Cool case! Here is my take on it-

    Findings:
    – Ventrally distributed within the caudal subsegment of the left cranial lung lobe, there is a moderate increase in soft tissue opacity with air bronchograms and a lobar sign, consistent with an alveolar pattern. Throughout the remainder of the pulmonary parenchyma, there is a moderate bronchial pattern.
    – Diffusely, the pulmonary lobar bronchi are variably mildly to moderate dilated and peripherally blunted.
    – Associated with the cardiac silhouette, the apical margin is displaced to the right of midline.
    – In the abdominal cavity, there is left to right transposition of the abdominal organs.

    Conclusions: Ventrally distributed alveolar pulmonary pattern, diffuse bronchial pattern, bronchiectasis and situs invertus. In association with the reported chronicity and concurrent rhinitis, ciliary dyskinesia (e.g. Kartagener’s syndrome) with associated bronchopneumonia is considered as a primary differential and cause for the patient’s clinical signs.

  2. The left middle lung lobe alveolar pattern and lobar sign in the ventral aspect. The thoracic and abdominal structures are inverted (left sided structures are located on the right and the right sided structures are located on the left). These findings are consistent with situs inversus totalis and is commonly associated with ciliary dyskinesia which is likely the cause of pneumonia in the left middle lung lobe.

  3. MIld to moderate diffuse bronchocentric pattern. There is a focus of moderate bronchial lumen widening seen with some of the caudal bronchioles with an associated focal interstitial lung pattern. The cardiac apex and gastric fundus are situated towards the right side.

    Conclusion:
    Diffuse bronchial pattern with bronchiectasis and associated interstitial pattern.
    Total situs inversus

    Diagnosis:
    Kartagener’s syndrome signified by situs inversus, ciliary dyskinesia and rhinitis

  4. Findings:
    Two orthogonal views of the thorax are provided. There is a diffuse bronchial pattern over the lung field and a lobar sign in the left hemithorax, between the caudal part of the left cranial lobe and the left caudal lobe. The apex of the heart is pointing towards the right side. The fundus of the stomach and the spleen is on the right side and duodenum on the left. The stomach is filled with some material of mixed soft-tissue and air opacity. There is a small amount of air in the oesophagus.
    Conclusion:
    A chronic bronchial disease of various aetiology.
    Lobar sign represents an area of a consolidated lung lobe. DifDg – atelectasis, pneumonia; less probable bleeding and neoplasia.
    Malposition of the heart, stomach, duodenum and spleen indicates Kartagener’s syndrome. This syndrome fits well with the history and radiological findings in this patient.

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