Swyer-James syndrome (SJS) or Swyer-JamesMacLeod syndrome is a rare disorder characterized by roentgenographical hyperlucency of one lung, lobe, or part of a lobe. As originally described, it shows a unilateral small lung with hyperlucency and air trapping on radiographs. It is postinfectious obliterative bronchiolitis due to childhood respiratory infection. In SJS, the involved lung or portion of the lung does not grow normally. The characteristic radiologic appearance is that of pulmonary hyperlucency on chest X-ray/CT caused by over-distention of the alveoli in conjunction with diminished arterial flow detected on Tc-99 m MAA pulmonary perfusion scan. Radionuclide pulmonary ventilation studies are considered difficult to perform in very young children as patient co-operation is crucial to achieve adequate tracer entry into the lungs. We present here the case of a female child aged 2 years, who presented with chronic productive cough and fever off and on for 1.5 years. She had classical features on imaging and markedly diminished ventilation on Tc-99 m DTPA aerosol study. Our case highlights the typical findings on ventilationperfusion scan (V/Q scan) and suggests that it is possible to conduct a satisfactory ventilation study with Tc-99 m DTPA aerosol even in very young children.
An 80-year-old male patient presented to the orthopaedist for evaluation of low backache. A bone scan was performed using 740 MBq (20 mCi) 99m Tc-MDP. Wholebody planar images were acquired 3 h after injection (Fig. 1). The scan revealed normal physiological tracer uptake in skeletal system but irregular and heterogenous accumulation of tracer in the bladder (Fig. 2). To evaluate this abnormal accumulation further, the patient was given a dose of 40 mg furosemide and asked to drink plenty of water. He was instructed to void three to four times within 2-3 h. After 3 h, the urine became less radioactive. An SPECT-CT image of pelvis was acquired, and the images revealed intense multifocal uptake in multiple bladder polyps (Figs. 3, 4). Urine cytology was done, which subsequently revealed malignant cells. Further evaluation with cystoscopic biopsy confirmed transitional cell carcinoma (TCC) of the bladder. Intraoperatively multiple broad based polyps were seen in the dome of the bladder. Transurethral resection of the
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