We reviewed all available images from chest x-rays,
chest CT,
paranasal sinus x-rays and sinus CT studies of 12 patients who underwent rigorous evaluation at our institution.
KS was suspected on the basis of clinical features and/or situs viscerum inversus.
The patients with the suspect or diagnosis of KS,
underwent imaging studies for clinical reasons (ie,
because of chronic cough and/or persistent focal abnormality seen on a chest radiograph that was unresponsive to medical treatment).
The diagnosis of PCD was confirmed on the basis of a strong clinical phenotype,
results of electron microscopic ultrastructural analysis of the cilia obtained by nasal scrape biopsy,
and nasal nitric oxide measurement.8
Chest radiographs: we looked at routine posteroanterior and lateral chest radiographs.
They revealed situs inversus totalis with cardiac silhouette displaced to the left,
thickening of the bronchial walls,
atelectasis,
and findings suggestive of bronchiectasis in all of the patients.
When seen laterally,
the bronchiectasic airway has been described as tram tracks (Fig.
1).
Sinus radiographs have largely been supplanted by CT scans.
We analyzed conventional sinus X-rays consisting of three views:
- Waters view or semi-axial projection (maxillary sinuses);
- Caldwell view or frontal projection (frontal and ethmoid sinuses);
- Lateral view (sphenoid sinus,
posterior walls of the frontal and the maxillary sinuses);
- Axial view .
These exams typically demonstrate mucosal thickening,
air-fluid levels,opacified sinus cavities,
and hypoplastic frontal sinuses.
X-rays provide limited information about the sinuses located at the bridge of the nose (ethmoid sinuses),
at the back of the nasal passage (sphenoid sinuses),
or about the bony structure that surrounds the drainage openings of the sinuses (ostiomeatal complex).
It is also difficult to differentiate between infection,
tumor,
and polyp in an opacified sinus.
Radiographs of the sinuses in infants aged three years or younger are not useful because of false “opacification” from undeveloped sinuses.
Sinus CT scan has become a useful diagnostic modality in the evaluation of the paranasal sinuses and an integral part of surgical planning.
CT scans ,typically obtained to visualize the paranasal sinuses,
should include coronal and axial (3-mm) cross sections.
A coronal CT image is the preferred initial procedure.
Bone window views provide excellent resolution and a good definition of the complete osteomeatal complex and other anatomic details that play a role in sinusitis.
A noncontrast CT scan is usually sufficient,
except for complicated acute sinusitis (e.g.,
periorbital cellulitis or abscess).
CT findings suggestive of chronic sinusitis include mucosal thickening,
opacified air cells,
bony remodeling,
and bony thickening due to inflammatory osteitis of the sinus cavity walls. These findings on CT scan should be interpreted in conjunction with clinical and endoscopic findings because of high rates of false-positive findings (fig.
2).
High-Resolution CT scan of the chest is the most sensitive modality to document early and subtle abnormalities within airways and pulmonary parenchyma when compared to routine chest radiographs.
First of all we have identified situs type.
Situs solitus is defined as normal thoracoabdominal symmetry and situs inversus totalis as mirror image reversal.
Some studies document markers of heterotaxy (situs ambiguus) including cardiac,
splenic,
hepatic and pulmonary anatomic abnormalities.9 All data pertaining to lobar distribution is presented as anatomic site (e.g.,
the anatomic right middle lobe is on the left in a patient with situs inversus totalis).
High-resolution CT showed bronchiectasis in all of the patients.
The right middle lobe was the most common lobe to manifest bronchiectasis.
The distribution of bronchiectasis was classified in each lobe as central (proximal 50% of lung parenchyma),
peripheral (distal 50% of lung parenchyma), or diffuse.
The presence or absence of peribronchial thickening and mucous plugging for each lobe was recorded (Fig.
3-4-5).7
Other radiographic findings were mucous plugging,
more present in adults than in children and emphysema,
mainly in the adults.