Asymptomatic Unilateral Hyperlucent Lung in a Prospective Kidney Donor.

Area of Science:

• Pulmonology
• Radiology
• Medical Diagnostics

Background:

• Swyer-James-MacLeod syndrome (SJMS) is an acquired lung disease resulting from post-infectious obliterative bronchiolitis.
• It typically presents with unilateral lung hyperlucency and can be asymptomatic until adulthood.
• Differential diagnoses for unilateral hyperlucent lung include pneumothorax, bullae, congenital lobar emphysema, and pulmonary embolism.

Purpose of the Study:

• To report a case of Swyer-James-MacLeod syndrome identified during preoperative evaluation of a prospective kidney donor.
• To discuss the diagnostic challenges and clinical implications of SJMS in an asymptomatic adult.

Main Methods:

• Clinical assessment including auscultation and vital signs.
• Radiological imaging: Chest X-ray (CXR) and High-Resolution Computed Tomography (HRCT).
• Pulmonary function tests (spirometry) with bronchodilator response and Technetium-99m MAA lung perfusion scan.

Main Results:

• HRCT revealed bronchiectasis and air trapping in the left lung with a small pulmonary artery.
• Spirometry indicated moderate obstructive abnormality with a paradoxical fall in FEV1/FVC post-bronchodilator.
• Lung perfusion scan showed significantly reduced function in the left lung (24.6%) compared to the right (75.4%).

Conclusions:

• The patient was diagnosed with Swyer-James-MacLeod syndrome, likely due to a childhood viral infection.
• Despite potential operative risks, the patient experienced an uneventful surgical and postoperative course.
• Early diagnosis and management of respiratory infections are crucial for patients with SJMS.