Bizarre Radiographic Finding in a Female Soldier.

CASE PRESENTATION

A 20-year-old female soldier with a 5-pack-year smoking history and unremarkable childhood respiratory illness presented with a 1-month history of intermittent cough and was referred to the chest department because of irregular findings on chest radiography during military service. Physical examination revealed slightly decreased breathing sounds in her right chest. Routine blood investigations and infectious survey were unremarkable; pulmonary function test revealed forced expiratory volume at the first second (FEV1) of 2.04 L (68.7% of predicted), forced vital capacity (FVC) of 2.29 L (67% of predicted), Tiffeneau index (FEV1/FVC) of 89.31% and total lung capacity of 3.69 L (80.8% of predicted). Chest radiography showed a large area of right-sided hyperlucency (Figure 1A). Computed tomography demonstrated emphysema and parenchymal scars in the lower lobe of the right lung without pulmonary artery interruption (Figure 1B). The clinical picture was compatible with Swyer-James-MacLeod syndrome. The patient was approved for military training after symptomatic treatment.

FIGURE 1

(A) Chest radiography showed a large area of right-sided hyperlucency. (B) Computed tomography demonstrated emphysema and parenchymal scars in the lower lobe of the right lung without pulmonary artery interruption.

Swyer-James-MacLeod syndrome is a rare syndrome developing secondarily to bronchiolitis obliterans and frequently occurs in infancy and in childhood after recurrent pulmonary infections characterized by hyperlucent appearance of 1 or more lobes of a unilateral lung. Most of the cases are asymptomatic and detected by incidental chest radiography obtained in adults; unilateral air trapping and hyperlucency signs on high-resolution computed tomography scan aid in precise diagnosis.1 The treatment includes early control of lung infections as well as influenza and pneumococcal vaccinations and surgery only for recalcitrant cases.2