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Swyer-James Syndrome & Bronchiolitis Obliterans

  • Definition

    Swyer-James syndrome (McLeod syndrome) is a result of unilateral post infectious bronchiolitis obliterans in infancy and early childhood.

    Bronchiolitis obliterans is a disease in which the bronchioles, and, occasionally some of the smaller bronchi, are partly or completely obliterated (blotted out) by nodular masses that contain granulation and fibrotic tissue.


    Bronchiolitis is inflammation of the bronchioles in the lungs. The consequences of bronchiolitis obliterans include dyspnea (shortness of breath), obstructive lung disease, atelactasis, bronchiectasis, and unilateral hyperlucent lung.

    Toxic fume bronchiolitis obliterans follows 1 to 3 weeks exposure to oxides of nitrogen, phosgene, and other noxious gases. The chest x-ray shows diffuse nonspecific alveolar or "ground glass" densities.

    Post infectious bronchiolitis obliterans is a late response to mycoplasma or viral lung infection in adults and has highly variable radiographic appearance.

    Another variant is bronchiolitis obliterans with organizing pneumonia (BOOP). This idiopathic (unknown origin) disorder affects men and women equally. Most patients are between the ages of 50 and 70. Dry cough, dyspnea, and a flu-like illness, ranging in duration from a few days to several months, are typical.


    Bronchiolitis obliterans may occur in association with rheumatoid arthritis, polymyositis, and dermatomyositis. Penicillamine therapy has been implicated as a possible cause of bronchiolitis obliterans in patients with rheumatoid arthritis.

    Bronchiolitis obliterans is a common complication of heart-lung transplantation and a rare complication of allogeneic bone marrow transplantation, the latter occurring in the setting of chronic graft-versus-host disease.


    Cough and dyspnea are common symptoms. fever and weight loss are common. physical examination demonstrates crackles in the lungs in most patients, and wheezing is present in about one-third.

    Pulmonary function studies demonstrate restrictive dysfunction and hypoxemia. The chest x-ray typically shows patchy, bilateral, ground glass or alveolar infiltrates. Solitary pneumonia like infiltrates and a diffuse interstitial pattern have also been described.


    Do any further tests need to be done to diagnose or to determine the cause?

    What is the cause?

    How severe is the condition?

    Can this condition be cured?

    Will any medication help keep the inflammation down? Will any medication be prescribed? If so, what are the side effects?

    Can you tell from the x-rays if the unaffected side might develop this condition?

    If the affected side is severe, will surgery be recommended?