Swyer-James-MacLeod

syndrome
It isa rare condition in which the lung (or portion of the lung) does not grow normally and is
slightly smaller than the opposite lung.
It is typically diagnosed after a chest X-ray or CT scanwhich shows unilateralpulmonary
hyperlucency (one lung appearing less dense) caused by overdistention of the alveoli in
conjunction with diminished arterial flow.
Radiographically, the imaging findings of SJS appear a few months to a few years after the
causative infection.
For patients with Swyer-James syndrome, chest CT scanning with thin collimation sections
on inspiration and expiration is the preferred examination.
In Swyer-James syndrome, the pulmonary vessels of the affected lung appear smaller than
normal on magnetic resonance imaging (MRI) scans.

Changes occur months to years after causative infection

Symptoms
Individuals with Swyer-James syndrome may not have any
symptoms, but affected individualscan have
chronicorrecurringlung infections, shortness of breath (dyspnea)
when performing an activity, coughing up of blood (hemoptysis),
and even severe respiratory impairment.

Cause

Most experts agree that theinitial abnormality occurs in the distal bronchi (air tubes
that bring air to and from the lungs)after an infection during early childhood.

The smaller size of the affected lung may be due to the infection inhibiting the normal
growth of the lung.

A number of reports have described Swyer-James syndrome following childhood

histories includingradiation therapy;measles;pertussis(whooping
cough);tuberculosis; breathing in a foreign body;mycoplasma; and viral infections,
especiallyadenovirus.

Research has suggestedthat a hyper-immune reaction in the lung (producing an

unusual abundance of antibodies) may play a role in sustaining airway damage after
the initial infection.

Some have argued a pre-existinglung abnormality may predispose individuals to the

condition.

Although bronchial damage of some kind during childhood is generally considered to

Diferential diagnosis
Possible imaging differential
considerations include
congenital lobar overinflation

(!!! may be
associated anaberrant left pulmonary arteryand also withcongenital
heart defects: ventricular septal defect (VSD), patent ductus arteriosus
(PDA), tetralogy of Fallot)

Hypoplastic lung syndrome

Bronchiolitis obliterans more diffuse
than Swyer James

Imaging

Anteroposterior chest radiograph of a 12-month-old patient

indicates diffuse pneumonia that is clearing on the right.

Imaging

Radiograph of the same infant shown in the previous image, now

20 months of age. The pneumonia has cleared. The left lung is
hyperlucent and is overexpanded. The right lung is small. The

Imaging

X-ray of a 4-month-old child shows pneumonia centrally

throughout the right lung. Pneumonia was caused by a severe
respiratory syncytial virus infection.

Imaging

Same child shown in the previous image, now 8 years of age. The
patient was experiencing severe wheezing and episodes of
hypoxemia. Note the small right lung and overexpansion of the

Imaging

A febrile, ill, 3-month-old infant with rales and rhonchi, which are
more severe on the left than the right.

Imaging

The same patient shown in the previous image, now 12 years of

age. Frontal radiograph shows the left lung to be somewhat small
and hyperlucent. The organism that caused the original

Imaging