Swyer-James syndrome

(McLeod syndrome, Swyer-James-McLeod syndrome, unilateral emphysema, small unilateral clear lung syndrome)

Very rare. Post-infectious  obliterans and constrictive bronchiolitis causing bronchial obstruction, retroobstructive emphysema and bronchiectasis as well as a fibrosis of the bronchioles and the interalveolar septa with progressive destruction of the adjacent capillary bed. Infections by Mycoplasma pneumoniae, Bordetella pertussis, Influenza A, adenoviruses, Pseudomonas aeruginosa and measles appear to be an triggering factor.

The symptomatology is variable:

-        incidental finding in an asymptomatic patient

-        recurrent lung infections

-        cough and tachypnea, dyspnea on exertion

-        hemoptysis

-        recurrent pneumothorax

-        pulmonary arterial hypertension.

Typical radiological aspect: hypertransparence of all or part of one lung associated with a trapping and dilation of the terminal airways (sometimes: cylindrical  or saccular bronchiectasies)

These patients sometimes require pulmonary resection to decrease the frequency of infections or improve lung function.

Anesthetic implications:

chronic respiratory infections, bronchiectasies, restrictive and obstructive syndrome. Resection of lung tissue requires unipulmonary ventilation which is generally well tolerated because the sick lung tissue is poorly perfused.

References : 

-         Brouard J, Freymuth F. 
Séquelles graves de pneumopathies virales et apparentées. 
In Pneumologie pédiatrique, coordinateur : J de Blic, Progrès en Pédiatrie 12, Doin, 2002, p 149-58.

-         da Silva PS, Lopes R, Neto HM. 
Swyer-James-McLeod syndrome in a surgically treated child: a case report and brief literature review. 
J Pediatr Surg 2012 ; 47 : e17-22.

-         Smith MM, Barbara DW, Smith BC, Sprung J, Weingarten TN. 
Anesthetic implications for patients with Swyer-James syndrome. 
J Cardiothor Vasc Anesth  2014 ; 28 : 937-42.

Updated: September 2018