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Ann Thorac Surg 1993;56:120-124
© 1993 The Society of Thoracic Surgeons

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Articles

Acquired segmental emphysema: The enlarging spectrum of Swyer-James/Macleod's syndrome

Thoracic Surgical Unit, Harefield Hospital, Harefield, and Department of Pathology, Mount Vernon Hospital, Mount Vernon, United Kingdom

Accepted for publication October 14, 1992.

^_* Address reprint requests to Mr Ohri, Cardiothoracic Unit, Department of Surgery, Royal Postgraduale Medical School, Hammersmith Hospital, London, W17 OHS, United Kingdom.

Three cases of Macleod's syndrome are described, all of which required surgical resections for distressing symptoms. This provided a rare opportunity tc examine the pathologic features of a condition that is usually diagnosed on ils radiologic features, and the etiology of which remains unestablished. Three patients (2 women and 1 man), aged 20, 23, and 24 years, were referred from respiratory physicians because of unilateral hyperlucent lungs and associated symptoms. All 3 patients had unilateral hyperlucent lungs, but only 1 patient had demonstrable mediastinal shift on expiratory and inspiratory chest computed tomographic scan. Segmentectomies were performed (n = 4) in all the patients without perioperative morbidity or mortality. Patients have been followed up between 6 and 18 months, and remain asymptomatic with a return to normal lifestyle. Histologic examination of the specimens found inflammation of the bronchus in all 3 patients, but only two specimens had evidence of bronchiolar inflammation. In only 1 patient was there a reduction in bronchiole number. All 3 patients showed presence of emphysema. These cases are notable for the segmental distribution of the disease. Pathologic examination lends support to the theory that previous respiratory tract infection may play a role in the pathogenesis of this condition.

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