ACQUIRED SEGMENTAL EMPHYSEMA - THE ENLARGING SPECTRUM OF SWYERJAMES MACLEODS-SYNDROME

Three cases of Macleod's syndrome are described, all of which required surgical resections for distressing symptoms. This provided a rare op portunity to examine the pathologic features of a condition that is us ually diagnosed on its 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 u nilateral hyperlucent lungs and associated symptoms. All 3 patients ha d unilateral hyperlucent lungs, but only 1 patient had demonstrable me diastinal shift on expiratory and inspiratory chest computed tomograph ic scan. Segmentectomies were performed (n = 4) in all the patients wi thout perioperative morbidity or mortality. Patients have been followe d up between 6 and 18 months, and remain asymptomatic with a return to normal lifestyle. Histologic examination of the specimens found infla mmation of the bronchus in all 3 patients, but only two specimens had evidence of bronchiolar inflammation. In only 1 patient was there a re duction in bronchiole number. All 3 patients showed presence of emphys ema. These cases are notable for the segmental distribution of the dis ease. Pathologic examination lends support to the theory that previous respiratory tract infection may play a role in the pathogenesis of th is condition.