A Case of Unilateral Hyperlucency of the Lung: a Rare Adult Occurrence of Swyer-James-MacLeod Syndrome

Abstract

Swyer-James-MacLeod syndrome is a rare pulmonary disorder that exhibits unilateral hyperlucency of a part of or the entire lung and because it is usually asimptomatic the diagnostic of this illness is discovered accidentally after a chest X-ray. Although the cause of this disorder is not completely understood, most authors believe that this is due to late sequela of infectious bronchiolitis that occurs during childhood. The symptoms presented by the individuals are often scarce at the moment of diagnostic, but a history of recurrent episodes of pulmonary infection accompanied by dyspnea, hemoptysis and/or chronic productive cough should raise the suspicion for such a diagnosis. Swyer-James-MacLeod syndrome can be interpreted as asthma or pulmonary embolism and this can result in inappropriate therapy. This case report describes a 38-year-old patient with chronic respiratory symptoms diagnosed on the findings of the chest X-ray and high resolution CT.

FIGURE 1.

Chest X-ray showing a hyperlucent left hemithorax with the reduction of interstitial design and low vascularization of the hilum

FIGURE 2.

Spirometry test portraying severe mixed ventilatory dysfunction

FIGURE 3.

CT exam showing hyperlucency of the entire left lung, decreased vascular markings on the left pulmonary area. Small left hilum compared to the one on the other side

FIGURE 4.

CT exam revealing focal “tree in bud” nodules in the apical region of the superior left lobe and diffuse bronchiectasis in the superior and inferior left lobes

FIGURE 5.

CT exam portraying focal “tree in bud” nodules in the posterobasale region of the inferior right lobe