Middle lobe syndrome in the left lower lobe in chronic obstructive pulmonary disease

Blaivas, Allen J.; Strauss, Walter G.

doi:10.4104/pcrj.2009.00018

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…If obstructive, surgery is needed to remove the cause or the entire lobe. In non-obstructive MLS, a medical approach is preferred, with bronchodilator and mucolytic agents, respiratory kinesiotherapy and immunostimulants [1, 2,16–18] .…”

Section: Discussionmentioning

confidence: 99%

Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman

Rua

Marques

Silva

et al. 2017

European Journal of Case Reports in Internal Medicine

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How to cite this article: Rua J, Marques R, Silva R, Gomes B, Fortuna J. Non-obstructive middle lobe syndrome: an unusual cause of recurrent pneumonia in an elderly woman. EJCRIM 2017;4: doi:10.12890/2017_000737. Conflicts of Interests:The Authors declare that there are no competing interests. This article is licensed under a Commons Attribution Non-Commercial 4.0 LicenseABSTRACT An 84-year-old woman had five episodes of pneumonia in 4 months. Despite extensive comorbidities and advanced age, her health status was good and the recurrence seemed unjustified. Exhaustive background investigation revealed 14 episodes of right-sided pneumonias during the 3 previous years and an inconclusive investigation with CT of the thorax and bronchofibroscopy, despite some fibrotic and atelectasic alterations in the right middle lobe. A new right-sided x-ray showed a wedge-shaped density extending anteriorly and inferiorly from the hilum, and CT of the thorax revealed aggravated middle lobe abnormalities with thickening of the bronchial wall and segment atelectasis, without any visible airway obstruction. After extensive work-up had excluded other causes of recurrent pneumonia and immunodeficiency, a non-obstructive middle lobe syndrome (MLS) was deemed responsible for the repeated episodes of pneumonia. MLS is characterised by chronic hypoventilation and atelectasis of the middle lobe, facilitating secretion accumulation, chronic inflammation and repeated infection. After treatment with bronchodilators and immunostimulants was initiated, the patient experienced no recurrences for several months. LEARNING POINTS• Recurrent pneumonia is common and has several possible causes. Investigation should be directed by whether or not the location of the episodes varies, suggesting a systemic condition or a local abnormality, respectively. • Middle lobe syndrome (MLS) is characterised by chronic hypoventilation of the right middle lobe resulting in atelectasis and secretion accumulation, sometimes causing recurrent pneumonia, and should therefore be considered in the differential diagnosis.• MLS is not unusual in children with asthma but is quite uncommon in the elderly despite age-related changes in the characteristics of airways with reduced elastic recoil and mucociliary clearance.

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Section: Discussionmentioning

confidence: 99%

Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman

Rua

Marques

Silva

et al. 2017

European Journal of Case Reports in Internal Medicine

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“…6 Infectious causes are most commonly bacterial, but can be viral, mycobacterial, or fungal. 7 It has been hypothesised that right middle lobe is relatively isolated lobe with lack of collateral ventilation from other lobes. Complete fissures surround the RML resulting in absence of collateral ventilation, leading to atelectasis, chronic inflammation and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

A Clinicoradiological Study of Middle Lobe Syndrome Due to Tuberculosis

Karmakar¹,

Hashim²,

Aamir³

et al. 2016

jebmh

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“…Sekerel et al [16] reported MLS in all pulmonary segments except the left upper lobe in children with bronchial asthma. Blaivas and Strauss [17] reported a case of MLS in the left lower lobe in a case of COPD. Others reported its occurrence in the lingua as well as the right upper lobe [1,18].…”

Section: Discussionmentioning

confidence: 99%

“…Ultimately, if atelectasis persisted or recurred, resection would be indicated. This strategy has been followed by several authors and its efficacy was proved in both paediatric and adult patients [10,17]. With this approach, only about one-third of patients required surgical resection [23].…”

Section: Discussionmentioning

confidence: 99%

Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome

Hamad¹,

Elmistekawy²,

Elatafy³

2012

Interactive CardioVascular and Thoracic Surgery

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Middle lobe syndrome in the left lower lobe in chronic obstructive pulmonary disease

Abstract: Middle lobe syndrome is a term that refers to a recurrent collapse of a lung segment, typically the right middle lobe. We discuss a case that middle lobe syndrome occurred in an unusual lung segment and related to an unusual cause.

Cited by 5 publications

References 5 publications

Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman

Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman

A Clinicoradiological Study of Middle Lobe Syndrome Due to Tuberculosis

Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome

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