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Unilateral hyperlucent lung: MacLeod versus Swyer–James
Clinical Radiology (2004) 59, 1048–1049
CORRESPONDENCE
Unilateral hyperlucent lung: MacLeod versus Swyer–James Sir—In 1953 P.R. Swyer and G.C.W. James reported a case of “unilateral pulmonary emphysema”.1 The patient was a 6-year-old boy with recurrent respiratory infections. The chest radiograph showed decreased size and “relative transradiancy of the right lung” with a considerable decrease in vascular markings. Bronchoscopy was normal and angiocardiography showed a normal heart and a small right pulmonary artery. The patient underwent pneumonectomy. Microscopic examination showed “considerable bronchitis and bronchiolitis”, “widespread obliteration of peripheral lung capillaries” and emphysema. In 1954 W.M. MacLeod described his observations in nine patients who had “abnormal transradiancy of one lung”, “small or normal size of the affected lung and absence of evidence of bronchial obstruction”.2 Expiratory radiographs showed air-trapping. The patients ranged from 18 to 41 years of age and were asymptomatic or had a cough with or without mild dyspnoea. Bronchoscopy was normal. Bronchography demonstrated decreased filling of the distal bronchi and alveoli on the affected side. Over the years this condition became variously known as unilateral hyperlucent lung, unilateral emphysema, MacLeod syndrome or Swyer–James syndrome. In recent years there has been an increasing tendency to only use the term Swyer– James syndrome. At first this may seem reasonable, as Swyer and James published their findings one year before MacLeod. However, MacLeod syndrome should be the preferred term because MacLeod described the condition as we see it most commonly, in young adult patients with mild or no symptoms that rarely if ever require pneumonectomy. Furthermore, MacLeod presented his study in February 1952 at the British Thoracic Society meeting in London2,3 one year before the publication of the Swyer and James manuscript. A recent letter to the Editor by two renowned Brazilian respirologists gives us perhaps a third reason to favour MacLeod.3 According to the authors of the letter (and they are highly reputable authors), Swyer and James were present at the 1952 meeting and probably were inspired by MacLeod’s presentation to publish their case. However, they did not make any mention of MacLeod’s presentation in their manuscript. MacLeod published his series in 1953 (at the insistence of his colleagues) and quoted the paper by Swyer and James.
Apparently this incident became public knowledge, ending with the dismissal of Swyer and James from the British Thoracic Society.3 Unfortunately, I have been unable to confirm that Swyer and James were indeed at the 1952 meeting or that they were expelled from the British Thoracic Society. My searches did, however, reveal some interesting information about W.M. MacLeod. According to Professor Lynne Reid (personal communication), MacLeod was a brilliant (sic) pulmonary physician working in Southampton, “a Scot with a sense of humour”. When asked what it felt like to have a syndrome named after him, he replied that it was like having a race horse: “one never knows how it will run”. No one knows indeed. What we do know is that the MacLeod horse has been losing but that it should be the winner. The unilateral hyperlucent lung syndrome should be considered synonymous with MacLeod syndrome.
References 1. MacLeod WM. Abnormal transradiancy of one lung. Thorax 1954;9:147–53. 2. Swyer PR, James GCW. A case of unilateral pulmonary emphysema. Thorax 1953;8:133–6. 3. Porto NS, Rubin AS. Carta ao editor. J Bras Pneumol 2004;30: 302.
N.L. Mu ¨ller Vancouver Hospital and Health Sciences Centre, Vancouver, Canada E-mail address: [email protected] q 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2004.08.004
Error and variation again Sir—The paper by Hillier et al.1 concludes that: “Registrars make a considerable number of errors affecting patient management when reporting CT..” This conclusion is plausible and likely to be true, but their data do not support it. First, the authors offer no clinical, biochemical, histological or surgical evidence that any error was made in any of their cases. Their errors are defined only in the mind of the senior observer.
CORRESPONDENCE
Unilateral hyperlucent lung: MacLeod versus Swyer–James Sir—In 1953 P.R. Swyer and G.C.W. James reported a case of “unilateral pulmonary emphysema”.1 The patient was a 6-year-old boy with recurrent respiratory infections. The chest radiograph showed decreased size and “relative transradiancy of the right lung” with a considerable decrease in vascular markings. Bronchoscopy was normal and angiocardiography showed a normal heart and a small right pulmonary artery. The patient underwent pneumonectomy. Microscopic examination showed “considerable bronchitis and bronchiolitis”, “widespread obliteration of peripheral lung capillaries” and emphysema. In 1954 W.M. MacLeod described his observations in nine patients who had “abnormal transradiancy of one lung”, “small or normal size of the affected lung and absence of evidence of bronchial obstruction”.2 Expiratory radiographs showed air-trapping. The patients ranged from 18 to 41 years of age and were asymptomatic or had a cough with or without mild dyspnoea. Bronchoscopy was normal. Bronchography demonstrated decreased filling of the distal bronchi and alveoli on the affected side. Over the years this condition became variously known as unilateral hyperlucent lung, unilateral emphysema, MacLeod syndrome or Swyer–James syndrome. In recent years there has been an increasing tendency to only use the term Swyer– James syndrome. At first this may seem reasonable, as Swyer and James published their findings one year before MacLeod. However, MacLeod syndrome should be the preferred term because MacLeod described the condition as we see it most commonly, in young adult patients with mild or no symptoms that rarely if ever require pneumonectomy. Furthermore, MacLeod presented his study in February 1952 at the British Thoracic Society meeting in London2,3 one year before the publication of the Swyer and James manuscript. A recent letter to the Editor by two renowned Brazilian respirologists gives us perhaps a third reason to favour MacLeod.3 According to the authors of the letter (and they are highly reputable authors), Swyer and James were present at the 1952 meeting and probably were inspired by MacLeod’s presentation to publish their case. However, they did not make any mention of MacLeod’s presentation in their manuscript. MacLeod published his series in 1953 (at the insistence of his colleagues) and quoted the paper by Swyer and James.
Apparently this incident became public knowledge, ending with the dismissal of Swyer and James from the British Thoracic Society.3 Unfortunately, I have been unable to confirm that Swyer and James were indeed at the 1952 meeting or that they were expelled from the British Thoracic Society. My searches did, however, reveal some interesting information about W.M. MacLeod. According to Professor Lynne Reid (personal communication), MacLeod was a brilliant (sic) pulmonary physician working in Southampton, “a Scot with a sense of humour”. When asked what it felt like to have a syndrome named after him, he replied that it was like having a race horse: “one never knows how it will run”. No one knows indeed. What we do know is that the MacLeod horse has been losing but that it should be the winner. The unilateral hyperlucent lung syndrome should be considered synonymous with MacLeod syndrome.
References 1. MacLeod WM. Abnormal transradiancy of one lung. Thorax 1954;9:147–53. 2. Swyer PR, James GCW. A case of unilateral pulmonary emphysema. Thorax 1953;8:133–6. 3. Porto NS, Rubin AS. Carta ao editor. J Bras Pneumol 2004;30: 302.
N.L. Mu ¨ller Vancouver Hospital and Health Sciences Centre, Vancouver, Canada E-mail address: [email protected] q 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2004.08.004
Error and variation again Sir—The paper by Hillier et al.1 concludes that: “Registrars make a considerable number of errors affecting patient management when reporting CT..” This conclusion is plausible and likely to be true, but their data do not support it. First, the authors offer no clinical, biochemical, histological or surgical evidence that any error was made in any of their cases. Their errors are defined only in the mind of the senior observer.