Unilateral Hyperlucent Lung Research Articles

Swyer – James – McLeod syndrome in an adult male

Swyer – James syndrome, also called Swyer – James – MacLeod syndrome (SJMS), is a rare acquired disorder characterized by pulmonary artery hypoplasia, unilateral hyperlucent lungs, and usually also bronchiectasis. Adults with SJMS are often diagnosed with and treated for chronic obstructive pulmonary disease (COPD), bronchial asthma, pneumothorax, or pulmonary embolism due to the similar clinical manifestations. Underestimation of an important radiological sign – unilateral “impoverishment” of the pulmonary pattern and hyperlucent lung – leads to erroneous diagnosis and inadequate treatment. Diagnosis of SJMS involves a computed tomography scan of the chest.The aim of this work was to familiarize readers with aspects of diagnosis and detail the clinical, radiological, and other characteristics of a patient with McLeod syndrome. The described adult man was diagnosed with SJMS at the age of 32. Some typical mistakes in examinations of such patients and the lack of vigilance of radiologists in case of unilateral hyperlucent lung are presented.Conclusion. Using the example of a rare clinical case of SJMS, we demonstrated the need to consider this syndrome when diagnosing adults with unjustified shortness of breath and a history of frequently recurrent pulmonary infections, with radiological signs of unilateral pulmonary emphysema and hyperlucent lung. According to the literature and our observations, computed tomography of the chest organs is a fast and reliable method for establishing the diagnosis of SJMS.

Unilateral hyperlucent lung: Swyer James Macleod Syndrome

Swyer James Macleod Syndrome, also known as unilateral hyperlucent lung syndrome, is a rare lung condition characterized by the underdevelopment of one lung. This syndrome typically occurs in childhood and is often discovered incidentally during imaging studies for unrelated conditions.Individuals with Swyer James Macleod Syndrome may experience symptoms such as recurrent respiratory infections, shortness of breath, and decreased exercise tolerance. Diagnosis is typically made through imaging studies such as chest X-rays,computed tomography or ventilation-perfusion scans.

Isolated unilateral absence of pulmonary artery- an unusual cause of hemoptysis: a case report

BackgroundIsolated unilateral absence of one pulmonary artery (IUAPA) is a rare malformation and a rare cause of hemoptysis. It occurs due to malformation of the sixth aortic arch during embryogenesis. This condition has variable presentations like dyspnoea, reduced exercise tolerance, chest pain, pleural effusion, recurrent bronchopneumonia, pulmonary hypertension, and haemoptysis can be asymptomatic.Case PresentationWe describe a case of a 34-year-old female presenting with recent onset hemoptysis associated with mild dyspnoea and cough. Chest Radiograph revealed unilateral hyperlucent lung field which was later diagnosed as Isolated unilateral absence of pulmonary artery on high resolution computed tomography of chest with angiography.ConclusionAbsent pulmonary artery should be considered as an important differential in cases presenting with hemoptysis. This case emphasises the significance of combining computed tomography with pulmonary angiography to accurately evaluate and define congenital lung abnormalities.

Cesarean section in Swyer-James-Macleod syndrome: Anesthesia implications.

Dear Editor, Swyer-James-MacLeod Syndrome (SJMS) is a rare, acquired postinfectious condition characterized by bronchiectasis or emphysematous changes.[1,2] These patients have a high risk of perioperative pulmonary complications. A 28-year-old primigravida, at 24 weeks of gestation, came with dyspnea on exertion (grade-3) for the 3 months with no history of recurrent infections. On examination, there was diminished breath sounds on the left side. Chest radiograph (done with abdominal shield) showed left hyperlucent lung with reduced vascular markings and slight mediastinal shift. Rest of the investigations were normal. The patient was referred to chest physician for optimization and a diagnosis of Swyer-James syndrome with left lung bulla/pneumothorax was made. The patient was managed with bronchodilators (Metered-Dose Inhaler levosalbutamol and Tiotropium bromide) and breathing exercises (pursed-lip breathing, diaphragmatic breathing). Spirometry was not done since the patient was in the second trimester of pregnancy. The patient got symptomatically better and an elective cesarean section was planned. Blood gas analysis performed a day before surgery showed PH: 7.441, PCO2:25.6, PO2 = 70.6, Bicarbonate = 17, Base excess = 7.21, Oxygen saturation = 94.4%. High-risk written consent was taken and expected complications were explained. On the day of surgery, the patient was taken in the operation theatre after giving inhalational bronchodilators. Ondansetron 4 mg and ranitidine hydrochloride 50 mg were given intravenously 30 min prior to surgery. A 20-G intravenous cannula was secured, Ringer lactate was started and vital parameters were monitored. Spinal anesthesia with 10 mg of heavy bupivacaine and 25 micrograms of fentanyl in the right lateral position was given. The intraoperative period was uneventful. SJMS was first described in 1953 by Swyer and James, and later explained in detail by MacLeod. A chest radiograph demonstrates lobar or unilateral hyperlucent lung and normal or reduced volume of the affected lung. Patients can present with a multitude of symptoms ranging from asymptomatic with incidental radiographical diagnosis to severe symptoms such as dyspnea and repeated pulmonary infections.[1,2] This syndrome is usually diagnosed in childhood after an evaluation for recurrent respiratory infections, but sometimes they are asymptomatic and may be diagnosed in adulthood.[3,4] In a case series by S. S. Hadice et al.,[3] three out of four patients had no history of airway infection in childhood and were diagnosed in adulthood. The clinical incidence of SJMS in pregnancy is 1:2500.[2] The management focuses on early diagnosis, prevention, and treatment of recurrent pulmonary infections and vaccine administration.[2–4] Severe cases of SJMS may require anesthetic care cautiously tailored to significant obstructive pulmonary physiology.[5] Regional anesthesia should be preferred whenever feasible. Chopra S et al.,[2] reported the successful delivery in a case of SJMS under spinal anesthesia in emergency. Labor epidural anesthesia can also be used in electively scheduled patients and supplemented with low-dose spinal anesthesia before surgery, if required. General anesthesia is associated with risk of bulla rupture, worsening of pneumothorax, and other pulmonary complications. Drugs that can cause histamine release and bronchoconstriction should be avoided. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient and her father have given their consent for his images and other clinical information to be reported in the journal. The patient and father understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

SWYER JAMES: A SHIFT IN THE DIAGNOSIS

SWYER JAMES: A SHIFT IN THE DIAGNOSIS

SWYER-JAMES-MACLEOD SYNDROME (SJMS) WITH PULMONARY HYPERTENSION: AN UNUSUAL CASE REPORT WITH REVIEW OF LITERATURE

Swyer-James-Macleod syndrome (SJMS) is an uncommon disorder of the lungs resulting in unilateral hyperlucent lungs and decreased bronchovascular markings. It is typically diagnosed during childhood, although occasionally some patients are diagnosed in adulthood as an incidental nding. Pulmonary hypertension complicating this syndrome is very rare which poses a diagnostic dilemma and a challenge to manage such patients. We describe this unique case report which was initially misdiagnosed as uncontrolled bronchial asthma and later turned out to be SwyerJames syndrome associated with pulmonary hypertension.

Swyer-James-Macleod Syndrome, Unilateral Hyperlucent Lung In Adulthood: A Case Presentation

SWYER-JAMES-MACLEOD SYNDROME (SJMS) is a rare pulmonary disorder that manifests as unilateral hyperlucent lung. HRCT is a novel imaging modality to diagnose SJMS since Chest radiographs underestimate this condition. We report a case presentation of SJMS in a 54-year-old male and treated with bronchodilators and i.v antibiotics. In conclusion, only a few with SJMS in adulthood has been reported worldwide.

An unusual case of unilateral hyperlucent lung

Differential diagnoses of unilateral hyperlucent lung are expansive, ranging from soft tissue to pulmonary parenchyma. A systematic approach to interpretation of radiography guides us in quick localisation of the anatomical site of involvement. https://bit.ly/3fNy4vT

A Systematic Approach to Demystifying the Unilateral Hyperlucent Lung

Causes of the unilateral hyperlucent lung consist of technical factors and congenital and acquired conditions. The goal of this article is to document the causes of the unilateral hyperlucent lung to increase the radiologist's familiarity with each of these conditions, ensure proper diagnosis, and help to guide appropriate treatment.

Challenges in multidisciplinary medical rehabilitation - Swyer-James-MacLeod Syndrome: case presentation and short literature review

Introduction. Swyer-James-MacLeod syndrome (SJMS) or unilateral hyperlucent lung syndrome is a rare disorder caused by infectious bronchiolitis obliterans and pneumonitis occurring in childhood. It is characterized by hypoplasia and/or agenesis of the pulmonary arteries resulting in pulmonary parenchyma hypoperfusion. Materials and methods. We report the case of a 27 years-old female patient who presented with progressive dyspnea, productive cough, fever and chills. Results and discussion. Chest radiography showed unilateral loss of left lung volume with hyperlucency. Unilateral reduction in vascularity with reduced caliber of the left pulmonary artery was revealed on CT scan of the chest, final diagnosis of SJMS being confirmed by angiography. Conclusions. This case strongly supports the recommendation of considering SJMS within the differential diagnosis workup of bronchiectasis, the syndrome being usually underdiagnosed.

ROLE OF HRCT THORAX IN TRACHEOBRONCHIAL FOREIGN BODY DETECTION

Background: Aspirated foreign bodies in the airway continue to present challenges to the otorhinolaryngologist and interventional pulmonologists. To established the role of HRCT in diagnosis of foreign bodies in suspected cases.
 Methods-30 patients with suspected FB inhalation on the basis of clinical history and symptoms like respiratory distress, stridor, and history of chocking were recruited for study in department of Otorhinolaryngology in Sardar Patel Medical College and Hospital, Bikaner Rajasthan.
 Results: 29 patients (96.67%) with foreign bodies were identified on chest CT. For the patients with tracheobronchial foreign bodies, the occurrence of unilateral hyperlucent lung and post-obstructive lobar or segmental infiltrates on plain chest X-ray was 43.33%. 17 patients (56.67%) had no abnormalities on plain X-ray. The difference between multidetector CT and plain X-ray results was statistically significant.
 Conclusion: Foreign bodies are missed byclinical and X-ray examination in many cases and that is only picked up by HRCT. Thus it is the ideal modality in diagnosis of foreign bodies to avoid the morbidity and mortality associated with missing foreign body.
 Keywords: foreign bodies, high resolution computed tomography, X-ray

Unilateral hyperlucent lung - What is the diagnosis?

Unilateral hyperlucent lung - What is the diagnosis?

Hyper-lucent one lung syndrome - MacLeod syndrome: A rare case associated with COPD

Hyper-lucent one sided lung syndrome or Swyer James Macleod syndrome is uncommon entity. Sometimes it might be associated after bronchiolitis obliterans infections occurring during earlier part of life. Resultant Pulmonary hypo perfusion because of incomplete or absent development of the pulmonary arteries resulting in a reduced amount of blood flow in lungs is a characteristic feature of it. Typically, this disorder is diagnosed incidentally in recurrent childhood respiratory infections evaluations or occasionally it may follow a silent course only to be diagnosed at adulthood. Here, we report a case in a 70-year-old male person with Swyer James Macleod syndrome incidentally diagnosed while workup for a COPD differentials who presented with dyspnoea on exertion, cough with expectoration. Hence this case highlights the importance of computerized tomography in the diagnostic workup of a case of hyper-lucent lung. All smokers presented with breathlessness and huperlucent lungs may not always be an emphysematous COPD cases. It could be a case of COPD with SJMS though extremely rare. Hence should be thoroughly investigated. Keywords: Bronchiolitis obliterans; Pulmonary artery abnormalities, Swyer-James/MacLeod syndrome; Unilateral hyper-lucent lung

Clinical features of post-infectious bronchiolitis obliterans in children undergoing long-term azithromycin treatment.

The aim of the present study was to outline any predisposing factors and clinical and radiological features of post-infectious bronchiolitis obliterans (PIBO) in pediatric patients, and to determine the effect of long-term azithromycin treatment on these factors. In total, 16 cases of children with PIBO were retrospectively reviewed. Adenovirus and Mycoplasma pneumoniae were the most common etiological agents (12/16) in the children with PIBO. The patients presented with persistent dyspnea, a chronic cough, sputum production and wheezing following the initial lung infection. Chest X-rays indicated pulmonary overinflation and patchy ground-glass opacity. In addition, high-resolution computed tomography (HRCT) scans revealed patchy ground-glass opacity, bronchiectasis, bronchial wall thickening and mosaic perfusion in all 16 cases. A unilateral hyperlucent lung was observed in two cases. All the patients underwent treatment with low-dose azithromycin and prednisone. Follow-up examinations of the 16 cases, varying in duration between 7 and 31 months, showed that the disease condition had improved in 10 cases. However, no significant improvements were identified from the HRCT scans or were observed in the patient condition in the additional six cases. The diagnosis of BO is primarily based on a typical clinical presentation and HRCT observations. Therefore, a typical clinical history and patchy ground-glass opacity features on HRCT scans are screening indices that predict BO development. Steroids are the cornerstone of BO treatment; however, long-term azithromycin treatment can improve the condition of the patients. In summary, PIBO is a disease with a high morbidity rate and should be treated by a multidisciplinary team. Patients should receive follow-up examination for an extended period. Patchy ground-glass opacity features on HRCT scans indicate that clinical suspicion of BO is necessary in children with persistent and severe wheezing.

左肺動脈低形成を合併した肺癌の1切除例

左肺動脈低形成を合併した肺癌の1切除例

Swyer-James-McLeod Syndrome

Admission chest x-ray of an 81 year-old man admitted to the hospital for atrial fibrillation with rapid ventricular response is shown in Figure 1. The chest x-ray shows a unilateral hyperlucent lung, with paucity of peripheral vessels and decreased lung volume. Differential diagnosis for unilateral hyperlucent lung includes Swyer-James-McLeod syndrome (SJMS), centrilobular emphysema, allergic bronchopulmonary aspergillosis, congenital lobar over inflation, bronchial atresia and congenital interruption of pulmonary artery.1 High resolution CT imaging confirmed the diagnosis of SJMS in this patient.

Cases Diagnosed with Swyer James Macleod Syndrome in Adulthood.

Swyer-James-MacLeod syndrome or unilateral hyperlucent lung syndrome is a rare disease characterised by hypoplasia of the pulmonary artery, unilateral hyperlucent lung and usually bronchiectasis. The syndrome was first described by Swyer and James in 1953 in a child case, and in the following year 9 adult cases were reported by MacLeod. We retrospectively reviewed 6 adult cases, five female and one male, who were followed-up with the diagnosis of Swyer-James-MacLeod syndrome between 2005 and 2012 in our clinic. The clinical and radiological features of these 6 cases are presented in the light of the literature.

Erişkin yaşta saptanan Swyer-James-MacLeod sendromu olgusu

Swyer-James-MacLeod syndrome (SJMS), or unilateral hyperlucent lung syndrome, is a rare disease thought to be associated with post-infectious bronchiolitis obliterans (1). This disease was first described in 1953 by Swyer and James in a 6-year-old child who had been treated with pneumonectomy (2). MacLeod presented a unilateral hyperlucency series one year later. From this date on, the disease was defined as Swyer-JamesMacLeod syndrome (SJMS) (3). This disorder is diagnosed in children with recurrent pulmonary infection or in asymptomatic adult cases during radiological examinations. The characteristic radiological findings include unilateral air trapping, hyperlucency signs, small or normal sized lungs, and a decrease in the number and dimensions of the pulmonary vessels (3).

Swyer–James–MacLeod syndrome with an anomalous origin of coronary artery: Case report

Swyer–James (Macleod) syndrome was first defined in the 1950s by Swyer, James and Macleod in patients with unilateral hyperlucent lungs. Coronary artery anomalies are congenital anomalies that affect a small part of the population. They constitute about 1–2% of congenital heart diseases. The incidence of a left coronary artery arising from the right coronary sinus Valsalva has been reported as 0.017%, and 1.3% among coronary artery anomalies. We hereby present this case since the case was diagnosed in adult age and was accompanied by a rare congenital heart disease.

Differential Diagnosis of Unilateral Hyperlucent Lung in Children

AJR 2013; 200:W95 0361–803X/13/2001–W95 © American Roentgen Ray Society Differential Diagnosis of Unilateral Hyperlucent Lung in Children Unilateral hyperlucent hemithorax occurs when there is a darker appearance of one side due to increased x-ray transmission. This appearance can result from a wide variety of diseases as illustrated by Wasilewska et al. [1] in the May 2012 issue of the AJR. We wish to supplement the list of causes illustrated by Wasilewska et al. by adding technical factors that may commonly lead to this appearance. It is essential to consider these factors in the differential diagnosis of the unilateral hyperlucency of the lung to avoid additional unnecessary investigations. Patient rotation is the most common cause of unilateral hyperlucency of the lung, seen in around 1% of chest radiographs [2]. The hyperlucency is always on the side toward which the patient is rotated and results from increased x-ray transmission because of the shorter tissue distance through which the xray beam passes. Evaluation of the distance of the medial ends of clavicles from spinous processes helps determine the extent of patient rotation. Technical error as a result of a miscentered x-ray beam or grid and the anode heel effect may also lead to unilateral hyperlucent hemithorax [3]. Lateral decentering (x-ray tube positioned lateral to the patient’s midline) results in hyperlucency because the x-ray beam is more intense and perpendicular to the side positioned nearby. Anode heel effect may also result in unilateral lung translucency because of increased absorption of x-rays emerging more parallel at the lower end of the anode target, resulting in decreased x-ray intensity in the direction of the anode relative to the cathode. Thoracic spine scoliosis is a rare abnormality that may also lead to unilateral hyperlucent hemithorax. Axial rotation of the spinal curvature in scoliosis likely may lead to asymmetric absorption of the x-ray beam by the chest wall, resulting in unilateral translucency. Further, supine chest radiographs with contralateral layered pleural effusion may also give an erroneous appearance of unilateral hypertranslucency of the opposite lung. We must consider these causes because they may also result in the appearance of unilateral hyperlucency of the lung. Akshay K. Saxena Vinayak Mittal Kushaljit S. Sodhi Post Graduate Institute of Medical Education and Research, Chandigarh, India