Middle lobe syndrome: a singularly rare presentation of complicated pulmonary hydatid disease

Abstract

Imaging is crucial to the diagnosis of pulmonary hydatid disease, as it is often the first modality that raises suspicion of the disease. Middle lobe syndrome (MLS) as a presentation of this disease is a distinct rarity. A 45-year-old woman, a never-smoker, presented with cough and streaky haemoptysis. Imaging demonstrated a trapezoidal opacity with its base towards the hilum and contiguous with the right cardiac border. The reformatted sagittal view confirmed the diagnosis of MLS. Fibreoptic bronchoscopy (FOB) revealed an avascular white membranous structure wholly occluding the medial segment of the middle lobe. This was completely removed through gentle suction. Bronchial aspirate revealed hooklets of hydatid and echinococcal serology was positive. Subsequently, three cycles of albendazole were administered with remarkable clinical and radiological improvement. To the best of our knowledge, this is the first detailed description of MLS caused by pulmonary hydatidosis that was completely removed through FOB.

Intact endobronchial hydatid cyst: an unexpected bronchoscopic challenge

“…Although, the role of bronchoscopy in the management of pulmonary hydatid cyst is controversial, 7 6 cases of complicated pulmonary hydatid cyst successfully removed by suction through a fiberoptic bronchoscope have been reported. 6 In our case, the intact endobronchial hydatid cyst was totally removed using biopsy forceps, without procedurerelated complications. To the best of our knowledge, this is the first nonsurgically treated case of intact endobronchial hydatid cyst with uneventful long-term follow-up.…”

“…5 Recent literature suggests that in selected cases of complicated pulmonary hydatid cyst, fiberoptic bronchoscopy may offer curative treatment, thus avoiding the need for surgery. 6 For uncomplicated (intact) pulmonary hydatid cysts, bronchoscopy is considered only if malignancy cannot be excluded by radiologic means, due to the possibility of rupturing the cyst. 7 We describe a rare case of intact endobronchial hydatid cyst that posed a diagnostic challenge because of an unusual imaging manifestation and unexpected bronchoscopic findings.…”

Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma

“…The diagnosis of ABPA is confirmed when the case presentation meets the criteria established in 2013 by the ABPA Working Group of the International Society for Human and Animal Mycology. If total IgE level are over 1000 IU/mL, two among three criteria are sufficient for establishing the diagnosis of ABPA: positive serum precipitins/Aspergillus fumigatus IgG, eosinophil count >500 cell/L, chest CT consistent with ABPA (mucus impaction, tree-in-bud pattern, centrilobular nodules, mosaic attenuation (31); high attenuation mucus, pathognomonic for ABPA (9,32); segmental, lobar and total lung collapse due to mucus plugs (33)(34)(35); central or peripheral bronchiectasis). Patients with a total IgE levels under 1000 IU/mL, who, otherwise, meet all the remaining criteria are also diagnosed with ABPA (9).…”

Middle lobe syndrome: an intriguing presentation of tracheobronchial amyloidosis

“…MLS is generally caused by endobronchial tumours, lymphadenopathies, foreign body or granulomatous infection and benign inflammatory causes 18 19. The infrequent causes of MLS include allergic bronchopulmonary aspergillosis,6 8 bronchial anthracofibrosis,20 endobronchial tuberculosis7 and pulmonary hydatid 9…”