Peripheral middle lobe syndrome.

Abstract

Classically, the middle lobe syndrome has been described as being caused by a central obstruction. Clinical records and radiologic findings were reviewed in 129 patients examined between 1955-1981 who had chronic disease in the right middle lobe and/or lingula. Fifty-eight patients (45%) had no evidence of a central obstructive lesion. The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients. Pathologic study showed varying degrees of chronic inflammation, pneumonia, and bronchiectasis. Surgical results were excellent in isolated disease. Chronic atelectasis and pneumonitis of the right middle lobe and/or lingula do not always imply central obstruction. A lack of collateral ventilation is a plausible theory to explain the pathophysiology in such patients.

Middle lobe syndrome as the pulmonary manifestation of primary Sjögrenˈs syndrome

“…Middle lobe syndrome is a disorder of recurrent or fixed atelectasis involving the right middle lobe and/or lingula 1 . ‐ 3 It can result from either extraluminal or intraluminal bronchial obstruction, but also may develop in the presence of a patent lobar bronchus without identifiable obstruction 1 . ‐ 3 Inflammatory processes and defects in the bronchial anatomy and collateral ventilation have been designated as the non‐obstructive causes of middle lobe syndrome 1 .…”

“…‐ 3 Inflammatory processes and defects in the bronchial anatomy and collateral ventilation have been designated as the non‐obstructive causes of middle lobe syndrome 1 . ‐ 3 …”

“…Compared with other areas of the lung, the middle lobe and lingula have a large ratio of pleural to non‐pleural surface because of the presence of deep fissures, which are effective barriers to the collateral ventilation. , 3 These anatomical features may thus predispose to the formation and persistence of atelectasis.…”

Middle Lobe Syndrome

“…The more complete the fissures, the greater the isolation of the middle lobe, the less collateral ventilation and the greater impairment of the cough mechanism and expectoration of secretions, predisposing to chronic inflammation and atelectasis. 10,16,19 A sequence of pathophysiologic events leads to the development of MLS, beginning with obstructive pneumonitis and culminating in destruction of the lung parenchyma. The procession of these events has been eloquently described by Effler and Ervin 2 as having 3 stages:…”

A Comparative Study of Video‐Assisted Thoracic Surgery with Thoracotomy for Middle Lobe Syndrome

“…The name of “middle lobe syndrome” (MLS) was suggested by Graham et al [ 1 ]. Extraluminal or intraluminal bronchial obstruction, recurrent atelectasis of the right middle lobe or left lingular segment was defined as MLS [ 2 ]. Most patients with MLS would recover by applying antibiotics and bronchodilators, especially for non-obstructive type.…”