Unilateral emphysema

Macleod's syndrome presenting with spontaneous pneumothorax

A 19-year-old woman with a recent history of recurrent bronchitis presented with a spontaneous left pneumothorax. Review of the chest radiographs revealed features of Macleod's syndrome on the same side, with unilateral lucency and hypoplastic hilar vessels. To our knowledge this is the first report of Macleod's syndrome presenting with spontaneous pneumothorax.

Computed tomography findings in the Swyer-James syndrome

A case of hyperlucent lung, the Swyer-James syndrome, diagnosed by computed tomography (CT) scan is presented. The CT findings and the role of this modality in establishing the diagnosis are discussed.

Lung tumor in a patient with congenital unilateral hypoplasia of the pulmonary artery

The occurrence of an undifferentiated carcinoma in the affected lung of a cigarette smoker with asymptomatic congenital hypoplasia of the right pulmonary artery is reported.

Regional lung function in patients with increased unilateral transradiancy of the lung in the presence of cardiac disease

Regional lung function has been studied with xenon-133 in two patients with unilateral transradiancy of the lung and coincidental cardiac disease. One patient had severe mitral stenosis with pulmonary venous and pulmonary arterial hypertension, the other had a secundum type of atrial septal defect with a pulmonary blood flow which was increased to 25 litres per minute. In both instances the overall perfusion of the transradiant lung was diminished but the regional distribution of blood flow was the same within both the `normal' and the transradiant lung. In the patient with mitral stenosis there was an abnormal increase in upper zone perfusion resulting in a reversal of the normal pattern of pulmonary blood flow while in the patient with an atrial septal defect the blood flow difference between the upper and lower zones was decreased and thus the normal vertical gradient was less. These studies suggest that the hypoplastic pulmonary arteries in the transradiant lung reacted in the same way to alterations in pressure and flow as the vessels in the other lung.

A physiological study of Macleod's syndrome

Seven patients with Macleod's syndrome of abnormal transradiancy of one lung have been investigated with special reference to regional lung function. The principal abnormality was found to be obstruction of the airways. This was severe in the affected lung but was often present in the other lung as well. Five of the seven patients suffered from chronic bronchitis, as judged by the M.R.C. questionnaire. Although functional impairment of the affected lung was severe, it was by no means uniformly distributed there. There was evidence of defective gas transfer in all the patients who complained of breathlessness on exertion; the blood gases were only slightly abnormal at rest, and hypercapnia, in particular, was not a feature. During exercise arterial oxygen tensions tended to fall. Clinically it was found that the stethoscope gave a rough guide to the extent of regional underventilation and that radiographs were useful for judging the distribution of blood within the lung. We conclude that treatment should be conservative, directed towards avoidance of environments and habits likely to cause or exaggerate airways obstruction or bronchitis.