Kartagener's triad; report of two cases.

Abstract

Kartagener's syndrome, a triad consisting of situs inversus with bronchiectasis and paranasal sinusitis, has been fully described by Adams and Churchill (1), and more recently by Zuckerman and Wurtzebach (7), who found that 40 cases had been reported up to 1950. Since then a case has been added by Cohen, Goldstein, and Hamill (3). The concomitance of situs inversus and bronchiectasis was first noted in 1904 by Siewert (6), who described a case of situs inversus in a twenty-year-old male with a productive cough since birth. A second case was reported in 1909, and another in 1923. Kartagener, in 1933 and 1935, reported 11 more cases and called attention to the added presence of paranasal sinusitis in these patients. Strictly speaking, however, this third member of the triad need not be present since, as is generally known, sinusitis occurs in approximately 90 per cent of cases of bronchiectasis, the two conditions having a causal and sequential relationship. It is the purpose of the present communication to report the incidence of Kartagener's triad at the State of Wisconsin General Hospital and to describe 2 recent cases. That the simultaneous occurrence of these abnormalities is not fortuitous is borne out by the disproportionately high incidence of bronchiectasis in patients with situs inversus as compared with that in the total number of hospital admissions. At the Massachusetts General Hospital, from 1866 to 1937 (1) the incidence of bronchiectasis was but 0.3 per cent in 232,112 admissions. During the same period, among 23 patients with situs inversus there were 5 cases of bronchiectasis and chronic sinusitis, an incidence of 21.7 per cent. At the Mayo Clinic from 1920 to 1941 (4) there were 85 cases of situs inversus, with bronchiectasis in 14, an incidence of 16.5 per cent, as contrasted to 0.5 per cent among all patients registered at the Clinic. At the State of Wisconsin General Hospital among some 262,000 admissions from 1922 to 1952, there are records of 13 cases of complete transposition of viscera. In addition, 1 case of Kartagener's syndrome was found among out-patients. Of the 13 hospital patients with situs inversus, 3 had associated bronchiectasis and paranasal sinusitis, an incidence of 23 per cent. Two of these cases are described below. In the third a bronchographic examination was not done. Case Reports Case I: P. S., a white male of 67, was admitted to the State of Wisconsin General Hospital in April 1952, complaining of bronchitis. Although the time of onset of symptoms is not definitely known, the patient appears to have had a productive cough most of his adult life. In the past ten years his symptoms had become progressively more severe and paranasal sinusitis and dyspnea had developed. The past history, except for symptoms relative to the present complaint, was non-contributory. Physical examination showed reddening of the nasal mucosa; otherwise the physical and laboratory findings were normal.