Macleod syndromeMacleod syndrome

Swyer James syndromeSwyer James syndrome

Dr/ Hytham Nafady

Definition Definition

Idiopathic hyperlucent lungIdiopathic hyperlucent lung

Etiology Etiology

Acute viral Acute viral bronchiolitis bronchiolitis during infancy during infancy that prevent that prevent normal normal development of development of the lungthe lung..

Central bronchiectasis

Acute obliterative bronchilolitis

Distal air space destruction

Pathology

C.PC.P

Asymptomatic in most cases.Asymptomatic in most cases. Cough, dyspnea on exertion.Cough, dyspnea on exertion. History of recurrent lower respiratory tract History of recurrent lower respiratory tract

infection during childhood.infection during childhood.

Location Location

Unilateral.Unilateral. Usually entire lung but may be lobar or segmental.Usually entire lung but may be lobar or segmental.

Plain radiographyPlain radiography and CT and CT

Unilateral Unilateral hyperlucencyhyperlucency.. SmallSmall pulmonary vessels pulmonary vessels (diminished number (diminished number

& size).& size). Small Small hilumhilum.. Small Small hemithoraxhemithorax.. Ipsilateral Ipsilateral mediastinal shift mediastinal shift (sometimes (sometimes

contralateral shift if associated with air contralateral shift if associated with air trapping).trapping).

Small pulmonary vessels Small hilum.Small hemi-thorax.

Ipsilateral mediastinal shift Unilateral hyper-lucency

CT bronchographyCT bronchography

Central bronchiectasisPeripheral bronchial cut off

pruned tree pruned tree bronchgrambronchgram

CT pulmonary angiographyCT pulmonary angiography

Diminished pulmonary vasculature.Diminished pulmonary vasculature.

Ventillation / perfusion lung scanVentillation / perfusion lung scan

Ventilation scan:Ventilation scan: Diminished ventillation.Diminished ventillation. Air trapping during expiration.Air trapping during expiration.

Perfusion scan:Perfusion scan: Diminished perfusion. Diminished perfusion.

DD of unilateral hypertranslucencyDD of unilateral hypertranslucency

Chest rotationChest rotation

Mastectomy Mastectomy

Poland syndromePoland syndrome

LobectomyLobectomyRight upper lobectomyRight upper lobectomy Left upper lobectomy.Left upper lobectomy.

Hyperlucent right lung.Hyperlucent right lung.The right hilum is elevated and The right hilum is elevated and become at the same level as the become at the same level as the left hilum.left hilum.

Hyperlucent left lung.Hyperlucent left lung.The left hilum is elevated.The left hilum is elevated.

Quiz Quiz

History:   10Y Boy with cough. 

A Pneumothorax.

B Lobar emphysema

C Pulmonary artery hypoplasia.

D Unilateral pulmonary edema.

E None of the above What to do next? CT

Findings:  CXR shows that the left hemithorax is lucent when compared with the right. The lungs are equally inflated. Vascularity is symmetric. The vessels are sharp. CT shows absence of left pectoralis major and pectoralis minor muscles.

Diagnosis:  Poland Syndrome

THANK YOUTHANK YOU