Chronic nonspecific pneumonitis with atelectasis occurring in the middle lobe of the right lung has recently been classified as a clinical entity and been called middle lobe syndrome. Middle lobe syndrome definition of middle lobe syndrome by. Surgical treatment of right middle lobe syndrome in children. Loss of the right cardiac silhouette, a mild collapse of the middle lobe, associated bronchiectasis. Middle lobe syndrome mls is a rare but important clinical entity that has been poorly defined in the literature. Ten years experience in surgical treatment of right middle. Pdf middle lobe syndrome mls is a rare but important clinical entity that has been poorly defined in the literature. It occurs in all age groups and is divided into an obstructive type, with a demonstrable. The concept that the disorder follows obstruction and compression of the middle lobe bronchus by diseased lymph nodes dates back to the report of brock, conn, and dickinson 3 in 1937, in which they described middle lobe. A 32yearold, neversmoker man presented with episodic dyspnoea and wheezing along with cough and mucoid sputum. Although termed middle lobe syndrome, it does occur in other areas of the lung, particularly in children with asthma. Middle lobe syndrome associated with major haemoptysis.
Recurrent collapse of the right middle lobe due to enlarged tuberculous lymph nodes was first described by brock et stains and cultures for al5 and is commonly known as brocks syndrome. Graham et al4 in 1948 described middle lobe syndrome mls as chronic or recurrent collapse of the right middle lobe. The middle lobe syndrome occurs more frequently than is generally appreciated. Middle lobe syndrome mls is a relatively uncommon lung disease that is characterized by damage to the middle lobe and often needs surgical intervention. Middle lobe bronchiectasis had been documented by ct 3 years earlier. Despite several series reporting the clinical features of mls, histopathological descriptions are rare. May 16, 2018 right middle lobe syndrome rmls generally refers to chronic or recurrent atelectasis in the right middle lobe of the lung. Pulmonary involvement in amyloidosis is a distinct rarity. In this series there were 4 children with allergy in whom persistent or recurrent atelectasis developed. There were 31 male and 67 female patients ranging in age from 4 to 80 years.
Fiberoptic bronchoscopy showed a narrowing of the right bronchus intermedius while the middle. Classically, the middle lobe syndrome has been described as being caused by a central obstruction. A patient who developed lung cancer in the course of longterm treatment for right middle lobe syndrome is described. A 10year study of 5 patients with isolated middle lobe atelectasis is presented. Chronic or recurrent collapse of right middle lobe, so called middle lobe syndrome is common in elderly woman. Right middle lobe syndrome brock syndrome md nexus. Middle lobe syndrome the annals of thoracic surgery. Middle lobe syndrome mls is an uncommon lung disorder involving the right middle lobe andor lingula and is characterized by a spectrum of clinical and pathological lesions ranging from recurrent atelectasis or pneumonias to bronchiectasis. According to several reports, tuberculosis was the most common cause of right middle lobe syndrome in south korea. Right middle lobe syndrome refers to chronic right middle lobe collapse, without an obstructing lesion.
We report on 2 case patients with rml syndrome, one due to infection with mycobacterium avium complex followed by. The syndrome is divided into an ob structive type demonstrable airway occlusion and a nonobstructive type patent right middle lobe rml bronchus. It was originally thought that bronchial compression by inflamed peribronchial lymph nodes e. The collapse is not usually associated with airway obstruction. Middle lobe syndrome mls refers to persistent or recurrent radiographic evidence of collapse of the right middle lobe. May 25, 2016 right middle lobe syndrome rmls is defined as recurrent or chronic atelectasis of the right middle lobe. Intrinsic obstruction of the right middle lobe bronchus. Isolated atelectasis of the middle lobe has been known for many years as the middle lobe syndrome. In a recent article, right middle lobe syndrome in children 197. Fiftyeight patients 45% had no evidence of a central obstructive lesion. Pulmonary tuberculosis presented with right middle lobe. Hemoptysis, chest pain, and dyspnea are also reported 1. A 67yearold man with a history of chronic obstructive pulmonary.
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. Colby, md middle lobe syndrome mls is an uncommon hmg disorder involving the right middle lobe andor lingula and is characterized by a spectrum of clinical and pathological lesions ranging from recurrent atelectasis or pneumonias to. The chest radiograph was suggestive of a middle lobe syndrome mls. This syndrome which is characterised by the chronic collapse of the middle lobe and bronchiectasis has been previously described in both adults and children 2, 3. Middle lobe syndrome is defined as recurrent or chronic collapse of the middle lobe of the right lung. Right middle lobe rml syndrome is defined as recurrent or chronic obstruction or infection of the middle lobe of the right lung.
The aetiology of mls is generally classified as being obstructive or nonobstructive. The blocked, contracted lung may develop pneumonia that fails to resolve completely and leads to chronic inflammation, scarring, and bronchiectasis. Epidemiology right middle lobe syndrome is usually encountered in older adults, with a predil. If the concept is limited to posttuberculous and nonspecific bronchostenosis with chronic atelectasis and inflammatory changes ofthe middle lobe, the term may be. Right middle lobe syndrome radiology reference article. The mechanism by which allergy or asthma leads to middle lobe syndrome is not well understood. It can be caused by multiple etiologies and the exact definition and prevalence remains obscure. Middle lobe syndrome, caused mainly by benign inflammatory diseases, such as chronic bronchitis and bronchiectasis, is manifested clinically as a chronic cough with sputum production. Defects in right middle lobe bronchial anatomy which characteristically has a fish mouth appearance, even in the normal state, inflammatory processes which cause surrounding lymphadenopathy, or abnormal collateral ventilation may be contributory factors. A diminished cough reflex due to the abnormal bony cage may further predispose the middle lobe and lingula to chronic inflammation and infection. Jan 14, 2016 middle lobe syndrome is an uncommon lung disorder associated with recurrent atelectasis, pneumonias, or bronchiectasis of the right middle lobe, lingula, or both. The term right middle lobe syndrome was originally coined in 1948 by graham, et al.
Apr 15, 20 middle lobe syndrome mls is an uncommon disease involving the right middle lobe andor left lingula. Highresolution ct hrct of the chest confirmed the presence of mls. Infectious causes of right middle lobe syndrome aatif. Original article from the new england journal of medicine middlelobe syndrome. Colby, md middle lobe syndrome mls is an uncommon hmg disorder involving the right middle lobe andor lingula and is characterized by a spectrum of clinical and pathological lesions ranging from recurrent atelectasis or pneumonias to bronchiectasis. Of 38 who had a thoracotomy, lung resection was possible in 25. Originally, extrinsic bronchial obstruction by the enlarged peribronchial lymph nodes was. Pdf on jan 1, 2018, amit panjwani and others published middle lobe syndrome find, read and cite all the research you need on researchgate. Ten years experience in surgical treatment of right. Although more commonly described in children, it is becoming more prevalent in adults with a predilection for women.
The recognition of the socalled middle lobe syndrome as a separate syndrome is scarcely justified becauseit is neither anaetiological, clinical, norpathologicalanatomical entity. The prognosis associated with this syndrome is considered good in most cases which are caused by chronic inflammatory diseases. Graham, burford and mayer1 and also paulson and shaw2 have called attention to the lesion. Malaise of the middle lobe of the right lung, due to compression of the middle lobe bronchus, usually by enlarged lymph. There are two distinct types of pathophysiology obstructive and nonobstructive. This clinical entity usually presents as tracheobronchial amyloidosis tba. Right middle lobe syndrome is characterized by a wedgeshaped density that extends. Chronic atelectasis and pneumonia of the middle lobe have been described as a clinical syndrome, of which the essential pathological feature isan obstruction. To study clinical, radiological and histological features of all patients who underwent surgical resection for mls in iceland over a. In our study most common symptoms were cough and difficult sputum expectoration followed by weight loss, haemoptysis, chest pain and dyspnea in frequency. First described in the medical literature in 1948, 1 it is caused by various etiologies and has no consistent clinical definition. Several clinical studies have shown that it may bae caused by malignant tumours. A 61 year african american man with a history of hypertension, diabetes presented to our clinic for a recurrent cough, felt to be related to.
Middle lobe syndrome mls is a rare, but important medical condition that remains poorly defined in the current literature. In right middle lobe syndrome, the middle lobe of the right lung contracts, usually because of pressure on the bronchus from enlarged lymph glands and occasionally a tumor. Nonobstructive causes of middle lobe syndrome include inflammatory processes and defects in the bronchial anatomy and collateral ventilation. Bronchoscopy and bronchography are vital in the rational approach to this syndrome. Role of infection in the middle lobe syndrome in asthma. Right middle lobe syndrome in children jama network. The essential pathological feature is a small atelectatic middle lobe. Obstructive mls can be caused either by endobronchial lesions or extrinsic compression of the rml bronchus. Infectious causes of right middle lobe syndrome moffitt cancer. Most of the patients with nonobstructive middle lobe syndrome due to mac seem to be thin elderly women for whom the prevalence of abnormalities of the chest wall and thoracic spine is high. The anatomy of the middle lobe bronchus contributes to the pathologic processes responsible for the symptoms and signs of this syndrome.
Right middle lobe syndrome definition of right middle lobe. Otherwise, a chronic cough is the most common symptom. Middle lobe syndrome is a constellation of symptoms that develop due to either intrinsic or extrinsic compression of the bronchus. All of them re sponded well to intensive medical therapy. A nationwide study on clinicopathological features and surgical treatment. The middle lobe syndrome chest journal american college of. Since that report, many other investigations have been reported which have led to the change. Middle lobe syndrome is frequently successfully managed medically. Right middle lobe syndrome is usually encountered in older adults, with a predilection for women see lady windermere syndrome.
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