swyer james ( mcleod 's ) syndrome ( sjms ) is a rare condition ( was seen 0.01% in 17459 cases ) characterized by unilateral hyperlucency of a part of or the entire lung , which was first described by swyer and james than macleod . first , this syndrome was thought to be congenital in origin and was attributed to hypoplasia of the pulmonary artery . sjms is a variant of postinfectious bronchiolitis obliterans that is most commonly the sequela of a viral ( adenovirus or rvs ) infection during infancy or early childhood . a 46-year - old male patient was admitted to istanbul university , cerrahpasa medical faculty , department of chest disease , istanbul in 2009 with dyspnea and chest pain . while examination of the patient it is learned that he had a history of multiple respiratory infections in childhood . chest x - ray ( cxr ) showed hyperlucency on the lower part of the right hemithorax [ figure 1 ] . chest x - ray showed hyperlucency on the lower part of the right hemithorax thorax computed tomography ( ct ) revealed bronchiectatic changes , hyperlucency of the lower part of the right hemithorax due to hypoplastic left pulmonary artery [ figure 2 ] . computed tomography revealed bronchiectatic changes , hyperlucency of lower part of the right hemithorax patient referred to the nuclear medicine department for ventilation - perfusion scintigraphy to rule out pulmonary thromboembolism . technetium-99m - labeled macroaggregated human albumin ( 99mtc - maa ) perfusion scan was performed after the injection of 185 - 200 mbq of 99mtc - maa into an anterocubital vein , and tc-99 m labeled carbon particles ( technegas ) was performed after inhalation of technegas with tidal breathing in upright position for ventilation scintigraphy . planar images and single photon emission computed tomography images of each scan were obtained by a double - headed gamma camera . vq images showed severe unilaterally matched vq defects on the right middle and inferior lobes . however , mismatched ventilation - perfusion pattern was shown on the upper right lobe , which was consistent with pulmonary embolism [ figure 3 ] . posterior , right posterior oblique ( rpo ) and right lateral perfusion images ( top row ) and posterior , rpo , right lateral ventilation images ( lover row ) showed unilaterally matched vq defects of the lower part of the right lung swyer  james  macleod syndrome is a rare lung disorder , which occurs as a result of childhood bronchiolitis obliterans . the onset of symptoms typically occurs during infancy or early childhood in association with frequent respiratory infections . patients usually present with productive cough , shortness of breath , and dyspnea on exertion . in sjms , involved lung or portion of the lung does not grow normally and is slightly smaller than the opposite lung . the characteristic radiographic appearance is that of pulmonary hyperlucency , caused by over distention of the alveoli in conjunction with diminished arterial flow . in general , this disorder is diagnosed in childhood after evaluations for recurrent respiratory infections . usual investigations performed are chest radiograph , high - resolution ct , magnetic resonance imaging , angiography , ventilation - perfusion scanning . james  macleod syndrome is usually diagnosed with chest radiography which shows hyperlucency of a lung lobe and a small hemithorax on the affected side . however , cxr can be insensitive and may appear normal . despite characteristic findings by chest radiography , ct is the most valuable imaging technique in the diagnosis of sjms . when using ct scan peribronchial thickening and the diagnosis of bullae and subsequent air trapping can be seen . james  macleod syndrome is often referred to as hyper- or trans - lucent unilateral lung because of the decreased parenchymal perfusion . although one lung or one lobe can be affected , ct has made it apparent that the disease may be more heterogeneous in distribution and contralateral parenchymal lesion may be present . ventilation / perfusion scintigraphy is a diagnostic modality that performed to rule out pulmonary embolism and shows a decrease in ventilation to the affected lung , secondary to emphysematous changes and a matched decrease in perfusion . in our patient , pulmonary angiography is extremely valuable in showing narrowed and withered tree - like pulmonary arteries in the affected side . magnetic resonance ( mr ) angiography demonstrates smaller pulmonary artery and its branches on the affected side . compared mr angiography with ventilation - perfusion scintigraphy in 11 patients and concluded that the magnetic resonance angiography is a fast , accurate , without radiation , and noninvasive technique for supporting the diagnosis of stevens  johnson syndrome . the important differential diagnosis of the sjms are congenital lobar emphysema , congenital hypoplasia of the lung , compensatory unilateral emphysema secondary to lobectomy , pulmonary embolic disease , pneumothorax , and foreign body in air way . all authors have assisted in preparation of the first draft of the manuscript or revising it critically for important intellectual content . all authors have read and approved the content of the manuscript and confirmed the accuracy or integrity of any part of the work .
swyer james ( mcleod 's ) syndrome ( sjms ) is an uncommon disease , which occurs as a result of childhood bronchiolitis obliterans . 
 patients may not be diagnosed until later in their life . a 46-year - old man underwent ventilation / perfusion scintigraphy for acute onset of dyspnea . 
 the scan showed markedly diminished ventilation and perfusion unilaterally on the right middle and inferior lobes . 
 however , mismatched ventilation - perfusion pattern was shown on the upper right lobe , which was consistent with pulmonary embolism . 
 unilaterally matched ventilation / perfusion defect can see in sjms in lung scintigraphy ; however , when pulmoner embolism may accompany , scintigraphy should be carefully examined .