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Situs inversus totalis with pleural empyema: a clue to ciliary dysfunction
Suraj Pai1, Anusha Induraj2, Aparna Mohan K1
1Cardiovascular and Thoracic Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangaluru, Karnataka, India.
BMJ Case Reports
|August 21, 2025
Summary
Situs inversus totalis (SIT) can indicate primary ciliary dyskinesia (PCD), a condition causing recurrent lung infections. Early recognition of SIT aids in diagnosing PCD and preventing severe pulmonary complications like empyema.
Area of Science:
- Medical Genetics
- Pulmonology
- Congenital Anomalies
Background:
- Situs inversus totalis (SIT) is a rare congenital condition with complete organ reversal.
- SIT is frequently associated with primary ciliary dyskinesia (PCD), a disorder of mucociliary clearance.
- Delayed diagnosis of PCD can lead to severe, progressive pulmonary damage.
Purpose of the Study:
- To highlight the association between SIT and PCD.
- To emphasize the importance of recognizing SIT as an early diagnostic clue for PCD.
- To underscore the need for timely intervention in patients with suspected ciliary dysfunction.
Main Methods:
- Case report of an adolescent male with SIT presenting with left-sided pleural empyema.
- Clinical evaluation including imaging and pleural fluid analysis.
- Surgical intervention: thoracotomy with decortication for trapped lung and empyema.
Main Results:
- The patient presented with symptoms suggestive of underlying ciliary dysfunction.
- Conservative management was unsuccessful, necessitating surgical intervention.
- Thoracotomy with decortication successfully re-expanded the lung and treated the empyema.
Conclusions:
- Situs inversus totalis serves as a crucial phenotypic marker for primary ciliary dyskinesia.
- Early identification of SIT can facilitate prompt diagnosis and management of PCD.
- Proactive intervention is essential to mitigate long-term pulmonary morbidity in patients with PCD.
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