Swyer-James Syndrome Diagnosed in a Trauma Patient

Background: Swyer-James syndrome is a relatively rare pulmonary manifestation of prior childhood lung infection that results in hypoplastic lung with small-caliber bronchi and pulmonary vasculature. It appears as increased opacity on chest X-ray study and can be confused for other thoracic disease processes. Case Report/Objectives: We present the confusing case of Swyer-James syndrome presenting in a trauma patient after a fall from 12 feet. The literature will be reviewed in regards to incidence, diagnosis, and management. Conclusions: Swyer-James syndrome occurs in < 0.01% of patients and is the result of usually recurrent childhood infections resulting in hypoplastic lung. It has classically been diagnosed with typical chest X-ray findings in the absence of obstructing lesions. More recently, diagnosis has been made by computed tomography. Management of the syndrome is typically conservative, with prevention and early treatment of pulmonary disease and, occasionally, resection for recalcitrant disease. In the presence of trauma, increased lung density on frontal chest X-ray study can be misconstrued as resulting from the trauma itself. This case outlines the need for emergency and trauma physicians to be cognizant of other etiologies of abnormal chest X-ray studies and to follow appropriate clinical pathways when working-up patients for chest trauma.