A 18-year-old women presented with chronic productive cough, and intermittent bilateral nasal obstruction. She had a history of recurrent episodes of respiratory tract infection and facial pain since childhood, and did not suffer from hearing loss or recurring otitis media. She could independently perform activities of daily living. On examination, the patient was pleasant, no chest pain, no distress, she spoke abnormally, and she had difficult to pronounce some letters. Blood pressure, pulse, oxygen saturation were normal. On chest auscultation, there were coarse crackles audible over both lung fields, and her heart sounds were heard best on the right side of the chest. Her chest X-ray PA view revealed the cardiac shadow and apex on the right side. She presents a dextrocardia (Figure 1). Electrocardiogram (ECG) showed inverted "P" waves in L1 and AVL on left-sided chest leads (Figure 2). High resolution computed tomography (HRCT) chest revealed bronchiectasis changes, CT abdomen confirmed situs inversus, and the sinus CT scan reveals maxillary sinusitis and filling of nasal pits mainly on the left side (Figure 3, Figure 4, Figure 5). in laboratory work-up, hemogram was normal, no anomaly in the protein electrophoresis, reactive protein C was normal, antinuclear antibody, antineutrophil cytoplasmic antibody,anti CCP antibody,rheumatoid factor, HIV serology were negative. Sputum for acid fast bacilli didn't reveal the tuberculosis bacilli. The speech therapy examination report revealed the presence rhinolalia clausa associated with a single articulation disorder. Nasal fiberoptic endoscopy was performed and showed bilateral grade 1 nasal polyposis and oral examination showed posterior rhinorrhea. Ear microscopic examination and the audiogram were normal (Figure 6). On spirometry, expiratory value in the first second (FEV1),84% of the reference value (2.31 l); forced vital capacity( FVC), 73% of the reference value (2.36 l); FEV1 /FVC, 97. She was diagnosed with kartagener syndrome based on her clinical and radiological presentation, and currently she is reviewed in speech therapy for reeducation and under local nasal corticosteroid. The evolution was favorable with a subsided of swelling on 6 months after the end of treatment. The child shows no signs of local recurrence or other tuberculous location.
HRCT of the chest in parenchymal window and in axial section reveals bronchiectasis and dextrocardia.