CTICasesPost-Infectious Constrictive Bronchiolitis (Swyer-James-MacLeod Syndrome)
Imaging findings
Chest radiographs demonstrate severe hyperinflation with flat diaphragms on the lateral view, along with regional rarefaction of the pulmonary vasculature at the lung bases. High-resolution chest CT shows extensive mosaic attenuation, prominent bronchial wall thickening, and mild bronchiectasis. A small, discrete subpleural gas collection of uncertain etiology is also noted at the left lung base.
Key takeaways
Constrictive bronchiolitis is a chronic, progressive small airway disease characterized by peribronchiolar inflammation and fibrosis leading to luminal obliteration. It is a well-recognized post-infectious sequela, most commonly triggered by severe adenovirus or Mycoplasma pneumoniae infections in childhood, which can result in Swyer-James-MacLeod syndrome. Young patients can maintain significant exercise tolerance and competitive athletic ability for years due to substantial physiologic reserves, even with severe underlying airway obstruction, before eventually requiring lung transplantation.
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