Swyer-James-MacLeod syndrome

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This young woman presented with gradually worsening dyspnoea over several years. There was no clear history of childhood infection.

Patient Data

Age: 33
Gender: Female
X-ray

Chest radiograph

The heart size and contour are normal.  There is hyperlucency of the left upper and mid zone without hyperexpansion or volume loss. No pneumothorax. No consolidation or pleural effusion. The right lung appears normal.

CT

CT

There is a focal area of hypodensity involving much of the left upper lobe.  There is markedly reduced vascularity within this hyperlucent segment.  No evidence of over expansion of the lobe. A posterior mediastinal mass is incidentally seen, slightly above fluid density and most likely representing a bronchopulmonary foregut duplication cyst.

Nuclear medicine

Qantitative V/Q scan

Quantitative analysis demonstrates photopenia within the superolateral aspect of the left upper lobe on the perfusion study with less pronounced defect on ventilation.

A diagnosis of Swyer-James-MacLeod syndrome was made. The patient underwent left upper lobectomy.

X-ray

Post-operative chest radiograph

Surgical clips projected over the left upper zone and left sided volume loss in keeping with left upper lobectomy.

Case Discussion

Although there was no clear history of childhood disease, Swyer-James-MacLeod (or Swyer-James) syndrome (do not confuse with MacLeod syndrome) is considered the late sequelae of bronchiolitis obliterans during childhood.

An important feature of this condition is air trapping during expiration. Bilateral disease is possible.

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Case information

rID: 22965
Case created: 8th May 2013
Last edited: 26th Apr 2016
System: Chest
Inclusion in quiz mode: Included

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