CTICasesSwyer-James-Macleod Syndrome
Imaging findings
Chest radiograph demonstrates hyperlucency of the left lung with small, sparse pulmonary vessels. High-resolution chest CT shows extensive, global bronchiectasis, airway wall thickening, and bronchovascular ground-glass opacities distributed across multiple lobes. The left upper lung displays marked oligemia and hyperlucency, with a severe reduction in pulmonary vessel size and number.
Key takeaways
Swyer-James-Macleod syndrome is an acquired post-infectious manifestation of childhood bronchiolitis obliterans that results in a unilateral or lobar hyperlucent lung. The characteristic hyperlucency and oligemia are caused by severe pulmonary artery hypoplasia and pruning, which are secondary to chronic alveolar hypoxia and alveolar hypoventilation. Patients often present in adulthood with bronchiectasis, chronic cough, and recurrent infections, and the apparent ground-glass opacities on CT may represent normal lung parenchyma contrasted against regions of severe air trapping and oligemia.
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