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Chronic Nasal Drainage and Congestion
This case features a patient with long-standing nasal congestion and rhinorrhea, ultimately diagnosed with primary ciliary dyskinesia (PCD) with Kartagener syndrome.
Imaging overview:
Coronal and axial NECT of the paranasal sinuses show diffuse mucosal thickening and opacification, with focal lobulated thickening along the right inferior turbinate corresponding to a sinonasal polyp. A PA chest radiograph demonstrates situs inversus with dextrocardia, supporting the diagnosis of Kartagener syndrome in the setting of chronic sinonasal disease.
Clinical insight:
PCD is an autosomal recessive disorder of motile cilia that impairs mucociliary clearance in the upper and lower airways and reproductive tract. About half of patients develop Kartagener syndrome, defined by the triad of chronic sinusitis, bronchiectasis, and situs inversus. Patients often present in childhood with recurrent sinusitis, otitis media, chronic cough, and later infertility or progressive respiratory failure. Recognizing the combination of diffuse sinonasal disease and situs inversus on routine CT and chest radiograph is key to suggesting this diagnosis and prompting genetic and functional ciliary testing.
Case courtesy of Savannah Jett, MD, and Nicholas Koontz, MD
Mayo Clinic Arizona.