Letters to the Editor: Swyer-James syndrome or destroyed lung?/ Coronary artery bypass in a patient with Swyer-James syndrome due to pulmonary tuberculosis

We read with great interest the recent article of Özcan et al. (1) about coronary artery bypass in a patient with Swyer-James Syndrome (SJS) secondary to pulmonary tuberculosis (TB). However, we do not agree with the authors regarding their diagnosis of Swyer-James Syndrome, but feel that it is more consistent with destroyed left lung secondary to pulmonary TB and compensatory left sided- mediastinal shift of right lung. It is well documented that SJS is a rare syndrome characterized by unilateral hyperlucency of one lung, lobe or part of a lobe which was first described in 1953 by Swyer and James (2) and further detailed by MacLeod (and called Swyer-James-MacLeod Syndrome (SJMS)). SJMS is considered a postinfectious manifestation of childhood bronchiolitis obliterans (BO). These respiratory infections include measles, whooping cough, TB, Mycoplasma pneumonia and influenza A (3, 4). BO results in inflammation and fibrosis in the walls and contiguous tissues of respiratory bronchioles with narrowing of their lumens (4). Fibrosis of the interalveolar septa results in obliteration of the pulmonary capillary bed secondarily diminishes blood flow to the major pulmonary artery segments, causing the hypoplastic arterial development. Because of the decreased parenchymal perfusion, this syndrome is often mentioned as translucent or hyperlucent lung (5, 6).