UNILATERAL HYPERLUCENT LUNG

We report a case of 33 year old man who consulted us in 1994 for recur rent bronchitis sometimes with haemoptysis. The physical examination w as unremarkable. At consultation abnormal fascicular sounds were noted at the left base. A chest x-ray showed hyperleucency of the left lung associated with a very small left hilar shadow. We considered the dia gnosis of Mac Leed's syndrome after eliminating a proximal obstructive pathology and pulmonary embolus. Mac Leod's syndrome or Swyer James' syndrome was described in 1954 and is suggested on the standard radiog raph above all if the expiratory films have confirmed the presence of air trapping. Angiography shows a slender and fine pulmonary network. Computered tomographic examination of the chest rules out a bronchial tumour, excludes bullous emphysema and reveals hyperlucent zones. Scin tigraphy with ventilation perfusion supplies the essentials to underst anding the mechanism (a syndrome of aerated lung which is neither dire ctly ventilated nor perfused). The expiratory function tests most ofte n show a restrictive syndrome but sometimes an obstructive syndrome is found with associated air trapping. The disorder does not progress an d the prognosis is good.