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A rare cause of wheeze in a young adult
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The plain radiograph and computed tomogram of the chest (see p 543) demonstrated considerable reduction in the volume of her right lung with hyperlucency, a paucity of vascular markings on that side, and mediastinal shift to the right, suggesting a possible diagnosis of Swyer-James-MacLeod syndrome (a rare disease with unilateral hyperlucent lung due to bronchiolitis obliterans and pulmonary artery hypoplasia, which generally develops after lower respiratory tract infection during early childhood).
Bronchoscopy (see p 543) revealed a pigmented tumour causing almost complete obstruction of the right main stem bronchus at the level of the carina.
The most likely diagnosis is a benign pigmented lung tumour, or a melanocytic carcinoid tumour. The age of the patient, her general wellbeing and health apart from wheeze on exertion, and never having smoked, make a malignant tumour unlikely.
The most appropriate management is surgical excision, in view of the symptoms of progressive
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- A rare cause of wheeze in a young adult
- E Moloney, C O’Keane, F Wood, and C Burke
Postgrad. Med. J. 2003 79: 543.[Extract] [Full Text] [PDF]
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