A man in his 70s in a rehabilitation hospital, post cerebral infarct, became acutely short of breath with reduced oxygen saturations and an elevated d-dimer.
Non-occlusive filling defects were noted on the CT pulmonary angiogram in the proximal left pulmonary arteries. There was associated hypoplasia of the distal pulmonary arterial tree in the left hemithorax with left pulmonary vein stenosis. Review of previous imaging suggested this oligaemia was longstanding.
Although filling defects in the pulmonary arteries usually correspond to embolic material, in our patient they were too dense to represent thrombus and probably represented flow-related artefacts in the setting of chronic air trapping.
Given the associated volume loss, bronchiectasis and bronchial wall thickening in the left hemithorax Swyer-James-McLeod syndrome was thought to be the most likely underlying cause.
- Respiratory medicine
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Contributors TH: initial reporter of the case, discussed with consultant body at LHCH and in a local interesting cases meeting, took consent from the patients NOK, wrote case report after collecting clinical information and discussing with ward team, etc, responsible for submission and changes etc. MG: reviewed case and case report, multiple drafts/revisions involved, provided support regarding salient points and take home messages, created figures including annotations—arrows, circles and HU, etc—after initial submission improved image quality to the required 300 dpi.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.