CTICasesAsymmetric Emphysema (Acquired Swyer-James Syndrome)
Imaging findings
Chest CT in a smoking woman born prematurely in 1940s rural North Dakota demonstrates dramatically asymmetric emphysema, markedly worse in the right lung, without endobronchial obstruction. The right pulmonary artery is small but patent, and the right bronchi are morphologically intact but show attenuated peripheral vessels. The left lung appears relatively normal for age.
Key takeaways
Severe asymmetric emphysema in an adult should raise the possibility of Swyer-James-Macleod syndrome, an acquired condition from childhood obliterative bronchiolitis (typically post-viral) resulting in unilateral or markedly asymmetric air trapping and emphysema. The presence of a normal pulmonary artery caliber and well-formed bronchi, as in this case, supports an acquired post-infectious etiology rather than a developmental abnormality.
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