Middle Lobe Syndrome: Diagnosis and Management

Saha, Sibu P.; Mayo, P; Long, Graydon A.; McElvein, Richard B.

doi:10.1016/s0003-4975(10)63193-1

Cited by 25 publications

(20 citation statements)

References 12 publications

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“…Bronchoscopy played an important role, and only one third of patients required surgical resection [15]. Furthermore, in a study on 98 adult patients with MLS, Saha et al [43] reported that only 32% required surgical resection for persistent disease.…”

Section: Treatment and Prognosis Of Mlsmentioning

confidence: 99%

Middle Lobe Syndrome: A Review of Clinicopathological Features, Diagnosis and Treatment

Guðbjartsson¹,

Guðmundsson

2012

Respiration

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Middle lobe syndrome (MLS) is a rare but important clinical entity that has been poorly defined in the literature. It is characterized by recurrent or chronic collapse of the middle lobe of the right lung but can also involve the lingula of the left lung. Pathophysiologically, there are two forms of MLS, namely obstructive and nonobstructive. Obstructive MLS is usually caused by endobronchial lesions or extrinsic compression of the middle lobe bronchus such as from hilar lymphadenopathy or tumors of neoplastic origin, resulting in postobstructive atelectasis and pneumonitis. In the nonobstructive type, no obstruction of the middle lobe bronchus is evident during bronchoscopy or with computerized tomography of the chest. The etiology of the nonobstructive form is not completely understood. Inefficient collateral ventilation, infection and inflammation in the middle lobe or lingula are thought to play a role, and bronchiectasis is the most common histological finding. Patients with proven endobronchial lesions or malignancy are usually offered surgical resection directly. This contrasts with nonobstructive MLS, where most patients respond to medical treatment consisting of bronchodilators, mucolytics and broad-spectrum antibiotics. However, some patients do not respond to conservative treatment and may suffer irreversible damage of the middle lobe or lingula, in addition to having recurrent symptoms of infection or inflammation. These selected patients can be offered surgical resection of the middle lobe or lingula, which is associated with a low mortality rate and favorable outcome.

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Section: Treatment and Prognosis Of Mlsmentioning

confidence: 99%

Middle Lobe Syndrome: A Review of Clinicopathological Features, Diagnosis and Treatment

Guðbjartsson¹,

Guðmundsson

2012

Respiration

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“…Prompt diagnosis, administration of antibiotics and the avoidance of irritating agents, such as smoke, may be effective. However, abnormal shadows on chest radiography persist even when symptoms have disappeared [4, 5]. We did not notice any antibiotic and/or anti-inflammatory interactions between roxithromycin and the drugs administered to patient 1.…”

Section: Discussionmentioning

confidence: 96%

Improvement in Right Lung Atelectasis (Middle Lobe Syndrome) following Administration of Low-Dose Roxithromycin

Kawamura

Arai²,

Tani³

2001

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Middle lobe syndrome is a distinct clinical entity characterized by right middle lobe atelectasis. Prompt diagnosis and initiation of medical therapy including the administration of antibiotics and the avoidance of irritating agents may be effective. However, abnormal shadows on chest radiography remain unchanged even when acute symptoms have disappeared, suggesting latent lesional inflammation or recurrence. We describe 2 cases of atelectasis in the middle lobe of the right lung which resolved completely after administration of low-dose roxithromycin. Thus, low-dose therapy with a macrolide could be of interest or some value in these cases, but it is too early to draw a definite conclusion.

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“…s e q u e s t r a t i o n these patients there was a kind of obstruction or tumor, in 17% nonspecific findings, and in 45% of the patients' bronchoscopy was normal. But the more recent studies 10,11,12) show non-obstructive reasons as the most common causes. Our normal bronchoscopies were same as previous studies, but we had more nonspecific findings such as infectious discharge in the right middle lobe bronchus, inflammation or granulation tissue, and some more specific findings includes bronchostenosis, tumor or foreign body.…”

Section: Discussionmentioning

confidence: 99%

Ten Years’ Experience in Surgical Treatment of Right Middle Lobe Syndrome

Pejhan

Salehi

Niusha

et al. 2015

ATCS

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Purpose: In this study we present the clinical, radiological, pathological, bronchoscopic and surgical results of 40 patients with diagnosis of middle lobe syndrome who were referred to our thoracic surgery unit for surgical intervention in a 10 years period. Methods: Forty patients with obstructive and non-obstructive causes of middle lobe syndrome referred to our thoracic surgery unit. Clinical data were collected from the patients' records in a ten years period. This study evaluates diagnostic approaches and surgical treatments in right middle lobe syndrome. Results: We studied 23 females (57.5%) and 17 males (42.5%) with a mean age of 31.7. Clinical findings were cough 95%, sputum 80% and intermittent hemoptysis in 50% of patients. Middle lobe collapse was seen in CT scan of all patients. Bronchiectasis was the most common pathologic finding (55%). Tuberculosis was not rare and was final pathology in 20% of patients. In three patients ruptured hydatid cyst was final finding. Surgery was done without mortality and with only minor complications. Conclusion: Lobectomy of right middle lobe is a good therapeutic option in these patients. Due to high prevalence of tuberculosis and hydatid cyst in Middle Eastern countries these two must be considered as causes of middle lobe syndrome.

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Middle Lobe Syndrome: Diagnosis and Management

Cited by 25 publications

References 12 publications

Middle Lobe Syndrome: A Review of Clinicopathological Features, Diagnosis and Treatment

Middle Lobe Syndrome: A Review of Clinicopathological Features, Diagnosis and Treatment

Improvement in Right Lung Atelectasis (Middle Lobe Syndrome) following Administration of Low-Dose Roxithromycin

Ten Years’ Experience in Surgical Treatment of Right Middle Lobe Syndrome

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