Situs inversus totalis with pleural empyema: a clue to ciliary dysfunction

Situs inversus totalis (SIT) is a rare congenital anomaly characterised by a complete mirror-image reversal of internal organ positioning. It is often associated with primary ciliary dyskinesia (PCD), a disorder characterised by defective mucociliary clearance and recurrent respiratory infections. Pulmonary complications are common in PCD, but diagnosis is often delayed unless phenotypic clues such as SIT are recognised early.We report the case of an adolescent male with SIT who presented with left-sided pleural empyema. Recurrent respiratory infections, along with characteristic imaging findings, raised suspicion for an underlying ciliary dysfunction, likely PCD. Initial pleural aspiration was non-yielding, and imaging revealed a trapped lung within a loculated pleural collection. As conservative measures failed, the patient underwent thoracotomy with decortication, resulting in successful lung re-expansion.This case highlights SIT as an important diagnostic clue for PCD and emphasises early recognition and intervention to prevent long-term pulmonary complications.