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A case of a nine year and eight months old child with Kartagener's syndrome (triad) is described: chronic maxillary sinusitis, bronchiectasis and "situs inversus totalis". Literature is reviewed. It is important to understand genetical and etiology aspects of bronchiectasis. Diagnosis was considered on the basis of physical and radiographic examination.

13 cases of congenital heart diseases in patients having atrial situs inversus and dextrocardia, all studied by means of angiography, are described following an up to date segmental approach. The type of atrioventricular connection was concordant in the 11 biventricular hearts; double inlet in the 2 univentricular hearts. The mode was always via two atrioventricular valves. In two cases the atrioventricular flows realized a criss-cross condition, being horizontal the interventricular septum, superior the morphologically right ventricle and inferior the morphologically left ventricle. In none of the univentricular hearts was an accessory chamber identified; they were both considered to be of indeterminate type. Ventriculo-arterial connections were: concordant in 3 cases (23%), including one case of Tetralogy with pulmonary atresia; discordant in 3 cases (23%); double outlet in 7 cases *54%). The aortic valve was in the assumed position (left and posterior to the pulmonary valve) only in the 3 cases with concordant as a rule. A ventricular septal defect was actually found in all cases; in one it was associated with pulmonary vascular disease. Obstruction to the pulmonary flow (subvalvular, valvular or vascular) was ascertained in 85% of cases, whereas aortic obstruction was never found. Overall, important congenital heart malformations appear to be frequently associated with situs inversus and dextrocardia. The ventriculo-arterial junction is identified as the most affected point.

The arteriographic findings are described and the embryology is discussed in a rare case of situs inversus of the abdominal viscera combined with reversed rotation of the bowel. The arteriogram correctly localized the precise site of hemorrhage in this perplexing case, and a complex surgical problem was simplified.

In 6307 cervicotomies for thyroid and parathyroid excision, 33 cases of nonrecurrent inferior laryngeal nerve were identified (0.52%). The anomaly was observed in 31 cases from 4921 dissections on the right side (0.63%) and in two cases from 4673 dissections on the left side (0.04%). Of the 31 patients who were initially seen with this anomaly on the right side, no innominate (brachiocephalic) artery was found; the right common carotid artery was arising directly from the aortic arch. The aberrant subclavian artery could always be felt against the vertebral column behind the esophagus. The two patients with the anomaly on the left side had a right aortic arch associated with situs inversus viscerum. In one case of invasive thyroid carcinoma, the nerve had to be sacrificed. In all of the other patients, postoperative laryngoscopic findings were normal. The nervous anomaly was of vascular anomaly origin in all cases. Predisposing factors for its onset during aortic arch development are discussed. Before surgical treatment, the diagnosis may only be made if vascular anomaly is suspected. Impairment of swallowing is the only clinical symptom to be looked for. The retroesophageal subclavian artery may be detected on chest x-ray films (20%) or by the compression and distortion of the esophagus shown during barium swallow tests (97%). Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for the inferior laryngeal nerve represents a major surgical risk. This is an additional argument in favor of systematic dissection of the inferior laryngeal nerve during thyroid or parathyroid excision.

Seven patients with corrected transposition were studied by qualitative radionuclide angiocardiography. In four patients with situs solitus with apex on the left, the pulmonary artery was in a medial and posterior position, to the right of the aorta, with its root attached to the morphological left ventricle positioned on the right. The aorta arose from the ventricle placed on the left and had an anterior position. The ventricle located on the right has a triangular shape. In the case of situs solitus with dextroversion, the pulmonary artery was to the right of the aorta and had a right-to-left direction. The ventricle placed on the right was ovoid. In one single case of situs inversus with levoversion, the pulmonary artery was on the left, emerging from the morphological left ventricle placed on the left, and was ovoid in shape, while the aorta was on the right arising from the morphological right ventricle. In one case of situs inversus with dextrocardia, atrioventricular relationships were the same as in levoversion but the apex was on the right and the morphological left ventricle was triangular. Qualitative radionuclide angiocardiography is a simple and non-invasive method for obtaining morphological data for the precise diagnosis of corrected transposition.

5 patients with this anatomic abnormality are dealt with. In literature the frequency of visceral inversion is 1:10000. In the GDR this would mean a total of approximately 1700 persons living with visceral inversion. Correct diagnosis is based on clinical examination and X-ray of the thorax. The danger of false diagnosis is especially given in cases of acute abdominal illness.

A case is reported of generalized acute abdominal pain in a school boy 11 years old with history of abdominal trauma produced by the introduction of a steel rod into the right hypochondrium. Laparatomy and prophylactic appendectomy were practiced and the diagnosis of situs inversus was made in his homestead. Six months later, the patient complained of intermittent abdominal pain, vomiting and absence of stools. With this picture, he was reoperated at this hospital where a right perforation of the diaphragm was found, through which the stomach, the epiploon and part of the ascending colon protruded into the chest. Said viscera were returned to the abdominal cavity and the diaphragmatic defect was sutured. The evolution was uneventful and the patient was discharged 10 days after surgery.

We report a patient with situs inversus and ischemic heart disease who had myocardial revascularization with anastomosis of the right mammary artery to the anterior descending coronary artery.

A right-sided heart associated with mirror-image atrial arrangement (situs inversus) is a rare condition. The incidence of coronary arterial disease in this setting is probably similar to that in the general population. Description of coronary angiography in this condition is very rare. We have recently catheterized such a patient. The necessary approach to coronary angiography is emphasized.

A 5-week old jaundiced female underwent hepatobiliary scintigraphy using technetium-99m disofenin. Early images suggested right-sided cardiac activity. A nearly symmetric, bilobed liver with left-sided predominance was discovered. No biliary ducts, gallbladder, or small bowel activity were demonstrated up to 24 hours post-injection. Laparotomy confirmed situs inversus, polysplenia, and extrahepatic biliary atresia.

A 7-month-old infant with ventricular inversion without transposition of the great arteries in situs solitus, associated with a ventricular septal defect, is reported. When the infant was 13 months of age, successful surgical repair was undertaken by performing an intraatrial transposition of venous return using the Senning procedure and by closing the ventricular septal defect with a patch. The postoperative course was uneventful except for a well-tolerated complete heart block. No systemic valve incompetence appeared during the 53 months of actual follow-up. A complete review of the literature suggests that this is the sixth reported instance of successful repair. Injury of the abnormally located conduction tissue is regarded as the most threatening complication.

Visceral situs, as evidenced by the position of the stomach and liver on the plain film, does not predict atrial situs as accurately as does bronchial situs. In particular situs ambiguus of the atria is not reliably indicated by visceral situs, and its subdivision into either right and left isomerism, where both atria show either right or left morphology respectively, cannot be made. As a result serious abnormalities of venous connections, which are common in the isomerisms, can be missed. Bronchial situs indicates atrial situs much more reliably and can be determined from penetrated chest radiographs or tomograms since the right and left main bronchi normally show different lengths. A ratio of lengths of 2 : 1 or more diagnoses bronchial situs solitus if the longer bronchus is on the left or situs inversus if the longer bronchus is on the right. A ratio of 1.5 : 1 or less indicates an isomerism. Data are presented from which the type of isomerism can be deduced and ratios between 2 and 1.5 : 1 clarified as isomerism or no isomerism.

Among more than 850 patients undergoing outpatient sclerotherapy of the internal spermatic vein, only 1 unilateral and 1 predominantly right-sided varicocele were encountered. In both patients with this finding a total situs inversus was present, with inversion of normal anatomy, enlarged "right" internal spermatic vein draining into the renal vein, and the "left" internal spermatic vein entering the inferior vena cava directly. Total situs inversus should be considered whenever right-sided varicocele is solitary or predominant.

The main types of heart positions and the malpositions are described as demonstrated on plain films of the thorax. Special attention is drawn to the situs ambi -- guous with the poly -- or asplenia which may be recognized from hypoarterial or epiarterial position of the main bronchi and their equal lengths and courses. This diagnosis is important because of the frequent accompanying congenital cardiac malformations and in respect to the planning of angiocardiography.

Transposition of the viscera is an uncommon condition but no figures are available as to its prevalence in a tropical country. 31 cases of dextrocardia were seen among 110,603 persons examined at two chest clinics in Sri Lanka. A further 11 cases were detected by the reading of films taken at a tuberculosis prevalence survey in the general population in which 27,095 persons were examined after random selection. The incidence at the chest clinics was 1 in 3567, while the prevalence in the general population was 1 in 2500, perhaps the highest rate to be reported from any country. The prevalence was higher in the rural than in the urban population. All cases were right handed, implying that there was no transposition of the centres in the brain. In one case the mother had mumps in the first trimester of pregnancy, thus raising the possibility of an aetiological relationship.

The results and value of conventional and axial angiocardiography were studied in 26 cases of atrioventricular discordance (AVD). The angiographic anatomy of this malformation was analyzed to determine the precise characteristics of atrioventricular and ventriculoarterial connections. The left and right ventricles in atrial situs solitus and levocardia show angiographic features that differ from those seen in atrial situs solitus and dextrocardia. The same differences are found in atrial situs inversus. Regardless of the type of ventriculoarterial connections, the ventricles maintain the same angiographic characteristics. The ventricular septum in AVD in situs solitus and levocardia and situs inversus and dextrocardia has a peculiar orientation. The use of axial angiocardiography facilitates detection and localization of the ventricular septal defect. In cases of malposition of the heart, the conventional frontal view allows visualization of the ventricular septum in all of its length. The axial projection is useful in diagnosing left ventricular outflow tract obstruction.

The purpose of this paper is to analyze 107 patients with anomalous heart location, divided into 6 main group, depending on type of heart formation, location of cardiac apex and topography of abdominal viscera. In most of the patients the associated congenital cardiac defects that were diagnosed were extremely severe, multiple, and cyanotic. Biplane angiocardiography is the most valuable instrument in the diagnosis of anomalous heart location. Surgical treatment of congenital cardiac defects in the presence of anomalous heart location has specific features, but in most of the patients these anomalies did not interfer with the total correction of potentially correctable defects.

Tc-99m biliary imaging was performed on a 34-year-old woman who was being investigated for suspected cholelithiasis. A left-sided liver was detected. On subsequent radionuclide imaging, partial visceral situs inversus and asplenia were demonstrated. Extensive roentgenographic investigation, ECG, echocardiogram, and laparotomy confirmed the radionuclide findings. Asplenia syndrome may exist without cardiovascular abnormalities and thus be undiscovered. Radionuclide imaging is important in the diagnosis of this syndrome.

In a patient with right-sided stomach and malrotation of the small bowel and cecum visualized by gastrointestinal x-ray studies using barium, a right-sided spleen was demonstrated by 99mTc-sulfur colloid and 51Cr-labeled red blood cell imaging. The sulfur colloid study also demonstrated that the liver was in its usual right upper quadrant location.

In the overwhelming majority of cases, varicocele appears in the left scrotum, the reason being the anatomical dissimilarity of the two sides. In patients with right-sided or bilateral varicocele, further investigation to rule out a retroperitoneal pathology, especially neoplastic, is indicated. On rare occasions, however, a vascular anomaly as the underlying pathology must be considered. A patient is presented with a complete situs inversus accompanied by a right-sided varicocele. Intraoperative right internal spermatic phlebography revealed that this vein drained into the right renal vein, and valvular incompetence at their confluence was the etiology of the disease. Intraoperative internal spermatic phlebography in patients with right-sided or bilateral varicoceles is recommended as the simplest and safest means to demonstrate the etiology of this disease.

Whereas normal liver and spleen scintiphotos with 99mTc- tin colloid are characterized by homogenous distribution of radiocolloid in the liver and slight uptake of radiotracer over the spleen in the anterior view, this report demonstrates that there is high radiotracer uptake in the spleen and slight uptake in the posterior view in a case of situs inversus.

Two cases of children with the syndrome (triad) of Kartagener are described. One of them presented two of the triad's components; the other one, probably complete, as a part of a partial revision of clinical charts, corresponding to children with "situs inversus", from 1970 to December 1973, at the Children's Hospital of Mexico. The literature is reviewed, concerning this unfrequently seen entity, finding a great majority of reports in children, less than 14 years old, a positive family history and serious respiratory disease complications on those affected. It is important to understand the early diagnosis and treatment of these patients, mainly if they have upper respiratory disease, to avoid future onset of bronchiectasis. The genetical aspects, as well as variable clinical affections are mentioned.