The Middle Lobe Syndrome and Its Quasi Variants

Banyai, Andrew L.

doi:10.1378/chest.65.2.135

Cited by 7 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MLS was first described in 1948 by Graham et al [3] as a chronic or recurrent collapse of the middle lobe due to hypoventilation resulting from mechanical obstruction or transient mucosal inflammation [2] . Limited collateral ventilation and the specific anatomy of the bronchus, which is narrow, long and has an acute take-off angle, are physiopathologically decisive [1, 7, 13] . There are two types of MLS, obstructive and non-obstructive, with the first subdivided into intrinsic or extrinsic, according to the nature of the obstruction [2] .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The most frequent clinical features are recurrent cough, dyspnoea, wheezing, chills, fever, haemoptysis and pneumonia [2, 13–15] . A typical wedge-shaped density extending antero-inferiorly from the hilum in the lateral thoracic x-ray suggests the diagnosis [1] .…”

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

View full text Add to dashboard Cite

show abstract

“…[7][8][9][10][11][12] In a study of 77 patients with middle lobe atelectasis Camishion et al9 pointed out that in the absence of bronchial obstruction, the condition is caused by secondary changes from bronchitis, pneumonitis, and the like, while atelectasis Svend Bertelsen, Eivin Struve-Christensen, Annet Aasted, and J0rgen Sparup in the presence of bronchial obstruction resulted from specific and non-specific lymphadenitis or malignant tumour. The present series confirms the high frequency of a malignant aetiology in middle lobe atelecttasis.…”

Section: Discussionmentioning

confidence: 99%

Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment of the so-called middle lobe syndrome.

Bertelsen¹,

Struve-Christensen²,

Aasted³

et al. 1980

Thorax

View full text Add to dashboard Cite

ABSTRtACT Isolated atelectasis of the middle lobe has been known for many years as the "middle lobe syndrome". Several clinical studies have shown that it may be caused by malignant tumours. A 10-year study of 135 patients with isolated middle lobe atelectasis is presented. Fifty-eight patients (43 %) had malignant tumours. Of 38 who had a thoracotomy, lung resection was possible in 25.In 20 patients regional or systemic dissemination of the tumour had been diagnosed before operation. Seventy-seven patients had benign diseases, of which 74 were non-specific infections. Bronchography was performed in 46 of these cases, and all had abnormal findings in the middle lobe, eight revealing definite bronchiectasis. In three cases tuberculosis was found. In 16 cases the benign diagnosis was established at thoracotomy. Only three patients out of 58 with malignant tumours lived more than five years. Atelectasis of the middle lobe is always a sign of potential malignancy especially in patients with a previously normal chest radiograph.

show abstract

“…The right middle lobe is not treated due to concerns of airway collapse secondary to right middle lobe syndrome. 19 In each session, the airway tree is carefully visualized, and the bronchoscopist devises a plan for systematically treating every visual airway in region being treated. In general, the bronchoscopist works from distal to proximal airways, and methodically works from a bronchopulmonary segment to immediate adjacent segments across the lobe until all visible airways that are 3 mm or greater in diameter are treated once and only once.…”

Section: Performing Bronchial Thermoplastymentioning

confidence: 99%