CTICasesSwyer-James Syndrome with Bilateral Post-Infectious Bronchiectasis and Bronchiolitis Obliterans
[...]. Swyer-James Syndrome with Bilateral Post-Infectious Bronchiectasis and Bronchiolitis Obliterans. CTICases. Published September 19, 2026. https://cticases.com/c/ny96a
Imaging findings
A 44-year-old man had a chest radiograph showing bubbly lucencies arranged radially at the lung base, recognizable as bronchiectasis, with a lucent left lung base and patchy opacity on the other side. CT from an outside institution showed dramatic bronchiectasis with hyperlucent, hypovascular lung and asymmetric lung volumes, one lung appearing small and the other hyperinflated. No expiratory images were available, but the lucent regions were devoid of vessels, reflecting reflex hypoxic vasoconstriction away from poorly ventilated lung. He had a severe infection requiring hospitalization at age two and breathing problems ever since.
Key takeaways
Swyer-James syndrome is post-infectious constrictive bronchiolitis obliterans, typically after a childhood lower respiratory infection, with accompanying bronchiectasis of the larger airways, air trapping, and reduced vascularity from hypoxic vasoconstriction. The pulmonology team had excluded it because the disease was not unilateral, but the original description relied on chest radiographs, which could only show the most affected side. CT often shows the process is focal and bilateral while remaining the same pathology, so bilateral involvement should not argue against the diagnosis.
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