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