Emphysema And Overinflation

Question 1

Swyer-James or Macleod syndrome

Answer 1

Unilateral pulmonary hyperlucency
One lung or lung portion doesn’t grow normally/ is smaller.
Insult to LRT, most commonly adenovirus
Sx: chronic cough, recurrent pneumonia or wheeze
No Rx, may improve with time

Question 2

Subcutaneous emphysema

Ddx

Answer 2

Pneumonthorax, pneumomediastinum
Fracture to orbit
Tracheotstomy
Pharyngeal ulcer or oesophageal wound 
Rarely asthma, abdo surgery
Very rare: gas producing bacteria in subcut tissues

Question 3

a1AT

• action
• early onset adult emphysema phenotype

Answer 3

Serum protease. Inactivates proteolytic enzymes released from dead bacteria or leukocytes
3rd-4th decade of life PiZZ (SERPINA1) or Pi null null
Lung disease rare in adolescence
HRCT
Rx IV a1AT weekly
Imms, smoking cessation

Question 4

Bronchiolitis obliterans

• define
• causes

Answer 4

COPD, fibrosis of small airways 
Lung & BM Transplant patients 
Adenovirus 
Mycoplasma 
Measles
Influenza 
Pertussis
Legionella 
JIA, SLE, SJS, scleroderma

Question 5

BOOP

• define
• Rx
• Prognosis

Answer 5

Fibrosing lung disease
Epithelial damage with abnormal repair
Inflammation results in obliteration of airway lumen
In BOOP inflammatory process extends to alveolar ducts & alveoli
Steroids for 1y
Total recovery in 60-80%
Can relapse- repeat steroids

Question 6

HRCT findings in BO

Answer 6

Mosaic pattern of hyperlucency
Air trapping
Bronchiectasis

Question 7

Follicular bronchitis
Define
HRCT findings

Answer 7

Lymphoproliferative disorder
Lymphoid follicles alongside bronchioles
? Post viral, associated w immunodeficiency
Fine reticular pattern, bronchiectasis
Rx Steroids
Prognosis variable