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Weekly Chest CasesArchive of Old Cases

Case No : 280 Date 2003-03-08

  • Courtesy of Kyung-Hyun Do, M.D., Joon Beom Seo, M.D. / Asan Medical Center, Seoul, Korea
  • Age/Sex 58 / F
  • Chief ComplaintDyspnea
  • Figure 1
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  • Figure 3
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Diagnosis With Brief Discussion

Diagnosis
Swyer-James Syndrome
Radiologic Findings
Chest PA shows unilateral hyperlucency in the left lung. Chest CT shows a low attenuated area and bronchiectasis. Vessels are sparse and small. CT scan also shows relatively small left hemithorax and mediastinal shift to midline.
Brief Review
Swyer-James syndrome (SJS) is considered to be a post-infectious form of bronchiolitis obliterans, pathologically defined by the presence of submucosal and peribronchiolar fibrosis with destruction and obliterative scarring of the small airways. SJS should be considered a spectrum disease with variable clinical manifestations and evolution that will be influenced mainly by the presence or absence of saccular bronchiectasis. Because the condition is usually acquired in childhood before the lungs have reached full development, the affected lung or lobe is usually small with reduced number of alveoli and subsequently hypodevelopment of the pulmonary arteries.
Chest CT is the imaging technique of choice for assessing these patients. It provided accurate information on the status of the hyperlucent lung and particularly on the presence and type of bronchiectasis. The combination of a small hyperlucent lung and a small pulmonary arterial system suggested the diagnosis of SJS. Additionally, chest CT demonstrated a high incidence of contralateral involvement, particularly well seen on expiratory slices.
The differential diagnoses are endobronchial obstruction, severe bronchiectasis complicated with atelectasis in one lobe and compensatory overdistension in the other lobe, and agenesis or hypoplasia of a pulmonary artery.
References
1. Lucaya J, Silvia G, Garcia-Pena P et al. Spectrum of manifestations of Swyer-James-MacLeod syndrome. J Comput Assist Tomogr, 22(4): 592-597.
2. Ghossian MA, Achkar A, Buy JN et al. Swyer-James syndrome documented by spiral CT angiography and high resolution inspiratory and expiratory CT: An accurate single modality exploration. J Comput Assist Tomogr, 21(4): 616-618.
3. Moore A, Godwin J, Dietrich P et al. Swyer-James syndrome: CT findings in eight patients. AJR 158: 1211-1215.
Keywords
Airway, Lung, Non-infectious inflammation,

No. of Applicants : 32

▶ Correct Answer : 29/32,  90.6%
  • - Annecy Hospital, France Gilles Genin
  • - Annecy Hospital, France Stephane Hominal
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Bharat Scans, Chennai, India R G Gopinath
  • - CHU Grenoble, France Gilbert Ferretti
  • - CHU Nancy-Brabois, France Denis Regent
  • - Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
  • - Chungju Hospital Konkuk University, Korea Chang Hee Lee
  • - Ewha Womans' University Hospital, Korea Sung Shine Shim
  • - GeumGang Asan Hospital, Korea Ju Youn Park
  • - Gwangmoung Seongae Hospital, Korea Jiyong Rhee
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Korea University Anam Hospital, Korea Bo Kyung Je
  • - Korean National Institute of Health, Korea Sang-Min Lee
  • - Maimonides Medical Center, New York, USA Naomi Twersky
  • - Narayana Hrudayalaya, Bangalore, India Nisha Sreenivasan
  • - National Medical Center, Korea Sang Kyu Yang
  • - National Taiwan University Hospital, Taiwan Kao-Lang Liu
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Prever-Centro Radiologico, Brazil Arismar Leon Pereira
  • - Samsung Medical Center, Korea Chin A Yi
  • - Samsung Medical Center, Korea Yeon Joo Jeong
  • - Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - Seoul National University Hospital, Korea Kyung Soo Cho
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Soroka University Medical Center, Beer-Sheva, Israel Pavel Crystal
  • - Teleradiology Solutions, Bangalore, India Sharad Bidari
  • - Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
  • - Ulsan University Hospital, Korea Kwang-Won Seo
▶ Semi-Correct Answer : 3/32,  9.4%
  • - Dept of IM, Seoul National University Hospital, Korea Jae-Joon Yim
  • - Hanyang University Hospital, Korea Seunghun Lee
  • - SUN Hospital, Uiwang, Korea Ki Taek Hong
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