Imaging |

Swyer-James-Macleod Syndrome Presenting as Unilateral Segmental Emphysema FREE TO VIEW

Abdulmonam Ali, MD; Nataliya Kozodoy, MD; Amal Milad, MPH; Ragheb Assaly, MD
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University of Toledo, Toledo, OH

Chest. 2015;148(4_MeetingAbstracts):500A. doi:10.1378/chest.2279185
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SESSION TITLE: Imaging Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Swyer-James-Macleod is a rare syndrome (SJMS) was first described by Swyer and James in a 6-year old boy with unilateral emphysema in 1953. One year later, Macleod reported a series of nine cases with unilateral hyperlucency [1].

CASE PRESENTATION: A 24 years old male presented to emergency department with acute non-exertional left sided chest pain. The pain was pleurtic in nature, non-radiating and non-reproducible. Physical examination revealed well developed man with normal vital signs. Chest was clear to auscultation, heart sounds were normal with no rub. EKG showed no acute ischemic or pericarditic changes. CT angiography of the chest showed a well-circumscribed hyperlucency in the anterior basilar segment of the left lower lobe with relative diminished vascularity (Figure 1). Expiratory CT scan films demonstrated a relative oligaemia and mild airway trapping on expiration. A ventilation perfusion scan showed matched defects in the left base. Fiberoptic bronchoscopy showed no evidence of endobrochial lesions or extrinsic compression. Careful review of the patient’s history from his mother, revealed history of premature birth at 30 weeks of gestation and history of early childhood whooping cough. Patient’s chest pain responded well to nonsteroidal anti-inflammatory drugs and was discharged stable condition.

DISCUSSION: SJMS is currently considered to be a post infective form of bronchiolitis obliterans. The classic radiographic appearance is increased hyperlucency caused by emphysematous change of the affected lung in addition to oligaemia secondary to hypoplasia of the pulmonary artery. SJMS may be associated with bronchiectasis, the presence and the extent of bronchiectasis is an important factor in determining the clinical manifestations and prognosis of the disease [1, 2]. Many case reports described the history of chest pain with SJMS. It is not clear whether the chest pain is related to the pathophysiology of the syndrome or not.

CONCLUSIONS: SJMS is considered a rare acquired disease. It usually diagnosed at childhood, however, some patients can be asymptomatic and diagnosed incidentally later in life [2]. Current imaging modalities like CT scan have further defined the disease pattern.

Reference #1: Sulaiman, A., et al., Swyer-James-MacLeod syndrome; repeated chest drainages in a patient misdiagnosed with pneumothorax. Interact Cardiovasc Thorac Surg, 2009. 8(4): p. 482-4

Reference #2: Lucaya, J., et al., Spectrum of manifestations of Swyer-James-MacLeod syndrome. J Comput Assist Tomogr, 1998. 22(4): p. 592-7

DISCLOSURE: The following authors have nothing to disclose: Abdulmonam Ali, Nataliya Kozodoy, Amal Milad, Ragheb Assaly

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