OBJECTIVE: We wanted to evaluate the resistance to collateral ventilation in congenital hyperlucent lung lesions and to correlate that with the anatomic findings on xenon-enhanced dynamic dual-energy CT. MATERIALS AND METHODS: Xenon-enhanced dynamic dual-energy CT was successfully and safely performed in eight children (median age: 5.5 years, 4 boys and 4 girls) with congenital hyperlucent lung lesions. Functional assessment of the lung lesions on the xenon map was done, including performing a time-xenon value curve analysis and assessing the amplitude of xenon enhancement (A) value, the rate of xenon enhancement (K) value and the time of arrival value. Based on the A value, the lung lesions were categorized into high or low (A value > 10 Hounsfield unit [HU]) resistance to collateral ventilation. In addition, the morphologic CT findings of the lung lesions, including cyst, mucocele and an accessory or incomplete fissure, were assessed on the weighted-average CT images. The xenon-enhanced CT radiation dose was estimated. RESULTS: Five of the eight lung lesions were categorized into the high resistance group and three lesions were categorized into the low resistance group. The A and K values in the normal lung were higher than those in the low resistance group. The time of arrival values were delayed in the low resistance group. Cysts were identified in five lesions, mucocele in four, accessory fissure in three and incomplete fissure in two. Either cyst or an accessory fissure was seen in four of the five lesions showing high resistance to collateral ventilation. The xenon-enhanced CT radiation dose was 2.3 +/- 0.6 mSv. CONCLUSION: Xenon-enhanced dynamic dual-energy CT can help visualize and quantitate various degrees of collateral ventilation to congenital hyperlucent lung lesions in addition to assessing the anatomic details of the lung.
Administration, Inhalation ; Child ; Child, Preschool ; Female ; Humans ; Lung/abnormalities/*radiography ; Lung, Hyperlucent/*congenital/physiopathology/*radiography ; Male ; *Pulmonary Ventilation ; *Tomography, X-Ray Computed ; Xenon/administration & dosage/*diagnostic use

Swyer-James syndrome (SJS) is characterized by a small- or normal-sized unilateral hyperlucent lung with decreased vascularity and air trapping on plain radiographs. SJS is considered to be a postinfectious form of bronchiolitis obliterans and has occurred following childhood pulmonary infection by adenovirus, measles, influenza virus, Bordetella pertussis, Mycobacterium tuberculosis or Mycoplasma pneumoniae. The standard treatment modality for SJS is supportive care. Despite the prominent role of inflammation in the pathogenesis of SJS, the use of corticosteroids has remained controversial. We report herein a case of SJS which was successfully treated with monthly methylprednisolone pulse therapy, resulting in complete remission as verified by high resolution computed tomography.
Adenoviridae ; Adrenal Cortex Hormones ; Bordetella pertussis ; Bronchiolitis Obliterans ; Inflammation ; Lung, Hyperlucent ; Measles ; Methylprednisolone ; Mycobacterium tuberculosis ; Mycoplasma pneumoniae ; Orthomyxoviridae ; Pneumonia, Mycoplasma

PURPOSE: Swyer-James syndrome is an uncommon abnormality characterized radiographically by a hyperluncent lobe or lung and functionally by normal or reduced volume during inspiration and air trapping during expiration. The condition typically follows certain respiratory infections in infancy or early childhood. Thus, it is a postinfectious form of bronchiolitis obliterans. Most patients have chronic cough, sputum, and abnormal breathing sounds, and present with repeated pulmonary infections. The syndrome affects pulmonary functions and may cause anatomical changes such as bronchiectasis and emphysema. We reviewed cases of Swyer-James syndrome, in order to better understand the clinical manifestations and outcomes of the disease. METHODS: The diagnostic criteria were small or normal-sized unilateral hyperlucent lung with air-trapping during expiration based on chest X-ray or CT and history of severe lung infection. A total of 12 patients were found. Medical records, radiological studies, and other clinical test results were reviewed. RESULTS: Most of the patients had chronic respiratory symptoms and signs. All patients had pneumonia or bronchiolitis as initial insult. Microbial agents were determined in six patients, of whom three were adenovirus and the others, Mycoplasma pneumoniae. They had restrictive and obstructive patterns of pulmonary function with bronchial hyperresponsiveness for methacholine. Two patients underwent lobectomy for emphysema and bullous emphysema, respectively. CONCLUSION: In this study, Swyer-James syndrome is a severe chronic pulmonary disease, presenting with respiratory symptoms, and functional and anatomical changes including bronchiectasis and emphysema. Further rejearch is needed to investigate initial etiologic agents and pathogenesis; further research is also needed for the care of chronic respiratory problems.
Adenoviridae ; Bronchiectasis ; Bronchiolitis ; Bronchiolitis Obliterans ; Cough ; Emphysema ; Humans ; Lung ; Lung Diseases ; Lung, Hyperlucent* ; Medical Records ; Methacholine Chloride ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Respiratory Sounds ; Respiratory Tract Infections ; Sputum ; Thorax

Adult ; Female ; Granuloma, Respiratory Tract ; pathology ; Humans ; Lung, Hyperlucent ; pathology ; Male ; Middle Aged

OBJECTIVETo evaluate the value of X-ray and spiral computed tomography (SCT) in the diagnosis of Swyer-James syndrome (SJS).

METHODSA total of 28 patients, 12 males and 16 females, were studied retrospectively. Ages ranged from 11 to 57 years, the mean age was 32 years. All patients underwent inspiratory chest X-ray films, 5 with expiratory chest films and 1 with bronchogram. Furthermore, inspiratory and expiratory SCT scans were performed. The SCT findings were analyzed and compared with X-ray films.

RESULTSSCT demonstrated 56 lobes with hyperlucency and diminished vascularity. The size of 51 lobes were smaller and 5 were normal. X-ray films showed that hyperlucency was only in 29 lobes, in which 19 lobes were small-sized and the other 10 lobes normal. There were 56 lobes with air-trapping on expiratory SCT scans, but only 5 lobes with air-trapping on expiratory X-ray films. Bronchogram in 1 case demonstrated bronchiectasis and bronchiolitis obliterans. SCT showed 24 patients with bronchiectasis, 9 patients with tuberculosis, 10 patients with bronchiolitis, and 2 with segmental collapse.

CONCLUSIONSCT scan is superior to chest radiography in the diagnosis and differential diagnosis of SJS.

Adolescent ; Adult ; Bronchiectasis ; complications ; diagnostic imaging ; Bronchiolitis ; complications ; diagnostic imaging ; Child ; Diagnosis, Differential ; Female ; Humans ; Lung, Hyperlucent ; complications ; diagnostic imaging ; Male ; Middle Aged ; Radiography, Thoracic ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Tuberculosis, Pulmonary ; complications ; diagnostic imaging

Swyer-James syndrome is a rare disease with patients presenting with unilateral hyperlucent lungs and hypoperfusion due to hypoplasia of the pulmonary artery and bronchiolitis obliterans. A unilateral hyperlucent lung generally develops after a lower respiratory tract infection during early childhood. In extremely rare cases, an association of bronchogenic carcinoma with Swyer-James syndrome has been reported. We report a case of bronchogenic squamous cell carcinoma associated with Swyer-James syndrome that performed right upper lobectomy and lymph node dissection with a relevant literature review.
Bronchial Neoplasms ; Bronchiolitis Obliterans ; Carcinoma, Bronchogenic ; Carcinoma, Squamous Cell* ; Humans ; Lung, Hyperlucent* ; Lymph Node Excision ; Pulmonary Artery ; Rare Diseases ; Respiratory Tract Infections

PURPOSE: To assess the high-resolution CT (HRCT) findings of small airway abnormalities after mycoplasma pneumonia and correlate them with the findings of chest radiography performed during the acute and follow-up phases of the condition. MATERIALS AND METHODS: We retrospectively evaluated HRCT and chest radiographic findings of 18 patients with clinical diagnosis of small airway disease after mycoplasma pneumonia (M:F=8:10, mean age: 8.3 years, mean time interval after the initial infection; 26 months). We evaluated the lung parenchymal and bronchial abnormalities on HRCT (n=18). In addition, presence of air-trapping was assessed on expiratory scans (n=13). The findings of HRCT were correlated with those of chest radiography performed during the acute phase of initial infection (n=15) and at the time of CT examination (n=18), respectively. RESULTS: HRCT revealed lung parenchymal abnormalities in 13 patients (72%). A mosaic pattern of lung attenuation was noted in ten patients (10/18, 56%), and air-trapping on expiratory scans was observed in nine (9/13, 69%). In nine of 14 (64%) with negative findings at follow-up chest radiography, one or both of the above parenchymal abnormalities was observed at HRCT. In four patients (27%), parenchymal abnormalities were seen at HRCT in areas considered normal at acute-phase chest radiography. Bronchiectasis or ateclectasis was observed in eight (44%) and four (22%) patients, respectively, at HRCT. The CT features of Swyer-James syndrome such as a unilateral hyperlucent lung with reduced lung volume and attenuated vessels were noted in two patients (11%). CONCLUSION: HRCT can clearly demonstrate lung parenchymal and bronchial abnormalities of small airway disease after mycoplasma pneumonia in children.
Bronchiectasis ; Bronchiolitis Obliterans ; Child* ; Diagnosis ; Follow-Up Studies ; Humans ; Lung ; Lung, Hyperlucent ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Radiography ; Radiography, Thoracic ; Retrospective Studies ; Thorax

The radiographic appearance of a unilateral hyperlucent lung is related to various conditions, the accurate radiographic interpretation of which requires a structured approach as well as an awareness of the spectrum of these entities. Firstly, it is important to determine whether a hyperlucent hemithorax is associated with artifacts resulting from rotation of the patient, grid cutoff, or the heel effect. The second step is to determine whether or not a hyperlucent lung is abnormal. Lung that is in fact normal may appear hyperlucent because of diffusely increased opacity of the opposite hemithorax. Thirdly, thoracic wall and soft tissue abnormalities such as mastectomy or Poland syndrome may cause hyperlucency. Lastly, abnormalities of lung parenchyma may result in hyperlucency. Lung abnormalities can be divided into two groups: a) obstructive or compensatory hyperinflation; and b) reduced vascular perfusion of the lung due to congenital or acquired vascular abnormalities. In this article, we describe and illustrate the imaging spectrum of these causes and outline a structured approach to accurate radiographic interpretation.
Artifacts ; Heel ; Humans ; Lung* ; Lung, Hyperlucent ; Mastectomy ; Perfusion ; Poland Syndrome ; Thoracic Wall

Mycoplasma pneumoniae(M. pneumoniae) is the leading cause of pneumonia in school-age children and young adults. The clinical courses are usually mild but recently, severe cases were reported such as lung abscess, Swyer-James syndrome and adult respiratory distress syndrome. Spontaneous pneumothorax associated with M. pneumoniae infection is rare. Carlisle reported a 6-year-old patient with bilateral spontaneous pneumothorax associated with M. pneumoniae infection and Koura also reported a 18-year-old girl with repeated. M. pneumoniae pneumonia with recurrent pneumothorax. We experienced bilateral spontaneous tension pneumothorax and subcutaneous emphysema associated with M. pneumoniae infection in a 6-year-old boy who presented with dyspnea, chest pain, and neck swelling. We reported it as the first case in Korea.
Adolescent ; Chest Pain ; Child ; Dyspnea ; Female ; Humans ; Korea ; Lung Abscess ; Lung, Hyperlucent ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Neck ; Pneumonia ; Pneumonia, Mycoplasma* ; Pneumothorax* ; Respiratory Distress Syndrome, Adult ; Subcutaneous Emphysema ; Young Adult

The Swyer-James Syndrome is a acquired pulmonary disease following bronchiolitis obliterans in young aged children, in which characteristic unilateral hyperlucence radiologically. Since Swyer and James first reported a case in 1953, it also has been named unilateral hyperlucent lung syndrome or MacLeod syndrome. Frequently there are repeated pulmonary infections which cause bacterial pneumonia and brochiectasis. In cases of pulmonary symptoms, it is diagnosed at early childhood, but there will be delayed detection until later ages in asymptomatic ones unless occasional chest radiography. Altogether the syndrome begins at childhood and manifested decreased exercise tolerance and failure to thrive, which means important disorder in pediatrics. Presently we experienced Swyer-James syndrome of 4 years old boy who had productive cough for 1 month diagnosed with a plain chest X-ray, lung computerized tomography and isotope lung scanning.
Bronchiolitis Obliterans ; Child ; Child, Preschool ; Cough ; Exercise Tolerance ; Failure to Thrive ; Humans ; Lung ; Lung Diseases ; Lung, Hyperlucent* ; Male ; Pediatrics ; Pneumonia, Bacterial ; Radiography ; Thorax