Patients whose disease is unresponsive to treatment and those with obstruc tive rml syndrome can be offered surgical treatment. Role of infection in the middle lobe syndrome in asthma. Ten years experience in surgical treatment of right. Our experience of these patients including their clinical and laboratory. Middle lung lobe syndrome an overview sciencedirect topics. Right middle lobe how is right middle lobe abbreviated.
Classically, the middle lobe syndrome has been described as being caused by a central obstruction. The blocked, contracted lung may develop pneumonia that fails to resolve completely and leads to chronic inflammation, scarring, and bronchiectasis. Learningradiology right, middle, lobe, syndrome, rml. When thymic carcinoma and middle lobe syndrome cooccur in the same patient, the thymic tumor might be addressed in priority to increase the chance of complete resection. Both show middle lobe atelectasis with silhouetting of the right heart border on the frontal view white arrows and a wedgeshaped density on the lateral with a depressed minor fissure yellow arrows. A 76yearold woman with incidental right middle lobe atelectasis.
Hemoptysis, chest pain, and dyspnea are also reported 1. Sixtyfive patients had full recovery following intensive medical therapy. Middle lobe syndrome as the pulmonary manifestation of. This clinical entity usually presents as tracheobronchial amyloidosis tba. These authors feel that the characteristic pattern of this type of. About 1 items found relating to right middle lobe syndrome. Fiftyeight patients 45% had no evidence of a central obstructive lesion. A 66 year old woman presented in extremis with symptoms and clinical and radiological signs of simultaneous obstruction of superior vena cava and middle lobe of right lung secondary to compression by a massive benign anterior mediastinal cyst. Necropsy findings established the relationship of nonmalignant tuberculous lymphadenopathy to the middle lobe syndrome and spontaneous right chylothorax. Our experience of these patients including their clinical and laboratory characteristics, indications forsurgical management, postoperative courses, and followup results was evaluated. The blocked, contracted lung may develop pneumonia that fails to resolve completely and leads to chronic inflammation.
Nonobstructive causes of middle lobe syndrome include inflammatory processes and defects in the bronchial anatomy and collateral ventilation. Since that report, many other investigations have been reported which have led to the change. To study clinical, radiological and histological features of all patients who underwent surgical resection for mls in iceland over a. At the thorax ctct angiography, hypoplasia of the main pulmonary artery and its branches and arteriovenous malformation. It was originally thought that bronchial compression by inflamed peribronchial lymph nodes e. Middle lobe syndrome in the left lower lobe in chronic obstructive pulmonary disease. Atelectasis of the right middle pulmonary lobe, with chronic pneumonitis. The prognosis associated with this syndrome is considered good in most cases which are caused by chronic inflammatory diseases.
Right middle lobe syndrome radiology reference article. The term right middle lobe syndrome was originally coined in 1948 by graham, et al. Middle lobe syndrome mls is a relatively uncommon lung disease that is characterized by damage to the middle lobe and often needs surgical intervention. This report describes our experience with the thoracoscopic approach to lung resection in a cohort of 4 consecutive patients treated with targeted antimicrobial therapy for several months prior to resection. Right middle lobe syndrome is a rare entity in children, causing high morbidity. The proposed hypothesis was based on the notion that lymphoid hyperplasia occurring around the right middle lobe bronchus produced compression and narrowing of the bronchial lumen. The right middle lobe was involved in 11 patients, the lingula in four patients, and both. Middle lobe syndrome associated with major haemoptysis. The right middle lobe is spared to reduce the theoretical risk of middle lobe syndrome 8, 16. In a recent article, right middle lobe syndrome in children 197. Pdf infectious causes of right middle lobe syndrome. Right middle lobe syndrome is usually encountered in older adults, with a predilection for women see lady windermere syndrome. Pdf right middle lobe rml syndrome is defined as recurrent or chronic. Ultrasonography of the neck showed thrombosis of the left internal jugular and other surrounding veins associated with local.
Pdf middle lobe syndrome mls is a rare but important clinical entity that has been poorly defined in the literature. Chest images at top are taken 3 months before images on bottom. Lady windermere syndrome refers to a subset of patients with ntm lung disease and isolated right middle lobe and lingular bronchiectasis. The definition of middle lobe syndrome subsequently has been modified to include all types of right middle lobe atelectasis, even when bronchial compression is not present. The concept of right middle lobe syndrome was highlighted in studies of children with chronic failure to thrive and right middle lobe abnormalities on chest radiographs. Right middle lobe syndrome in children jama jama network. While in the ed, an incidental right middle lobe collapse was found on ct abdomen. Neither clinical nor radiological evidence of recurrence was noticed. At the thorax ctct angiography, hypoplasia of the main pulmonary artery and its branches and arteriovenous malformation localized in the middle lobe of the right lung were detected. Massive benign pericardial cyst presenting with simultaneous. Right middle lobe syndrome in a 7yearold child sciencedirect. Sixtyfive patients had full recovery following intensive medical. Middle lobe syndrome definition of middle lobe syndrome. The right middle lobe rml or simply the middle lobe is one of three lobes in the right lung.
Graham, burford and mayer 1 and also paulson and shaw 2 have called attention to the lesion. Infectious causes of right middle lobe syndrome aatif. Right middle lobe syndrome brock syndrome md nexus. Pulmonary involvement in amyloidosis is a distinct rarity. Infectious causes of right middle lobe syndrome aatif rashid. Respiratory symptoms were refractory to usual treatment. May 12, 2011 right middle lobe syndrome is a rare entity in children, causing high morbidity. Abnormal findings on chest xrays and bronchograms showed complete or partial atelectasis of right. 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. Like all the pulmonary lobes, it is lined by visceral pleura which reflects at the pulmonary hilum where it is continuous. Wikimedia commons has media related to syndromes affecting the lung subcategories. The anatomy of the middle lobe bronchus contributes to the pathologic processes responsible for the symptoms and signs of this syndrome.
The right middle lobe lies in the lower anterior aspect of the right hemithorax and contains two bronchopulmonary segments. Middle lobe syndrome mls is defined as recurrent or chronic collapse of the middle lobe of the right lung. In fact, not only have the pathological criteria described by graham and associates lbeen ignored, but the clinical syndrome of cough, hemoptysis, and recurrent pneumonia. Upper extremity deep vein thrombosis is an extremely important clinical entity with potential for considerable morbidity and mortality. A patient who developed lung cancer in the course of longterm treatment for right middle lobe syndrome is described. First described in the medical literature in 1948, 1 it is caused by various etiologies and has no consistent clinical definition. Middle lobe syndrome description of middle lobe syndrome. In the chest radiography obtained before her ear surgery, volume decrease in the right hemithorax, elevation of the right diaphragm, and increase of ventilation in the right lung were detected. Middle lobe syndrome definition of middle lobe syndrome by. Surgical treatment of right middle lobe syndrome in children ncbi. A follow up xray continued to show atelectasis of the right middle lobe. 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. It is separated from the right upper lobe above by the horizontal fissure and the right lower lobe below by the right oblique fissure and is subdivided into two bronchopulmonary segments.
Middle lobe syndrome is a disorder of recurrent or fixed atelectasis involving the right middle lobe andor lingula. Right middle lobe syndrome in children jama network. Right middle lobe syndrome rml is a bronchoconstrictive and uncommon disorder of the lung. Bt is an outpatient procedure and may be performed under moderate sedation or general anesthesia. Bronchial anthracofibrosis and tuberculosis presenting as. Angiography identified an abnormal bronchial artery and venous shunting which was embolised satisfactorily. Middle lobe syndrome the annals of thoracic surgery. The problems of pleural cytologic interpretation are well known, as the following quotes verify. A case of swyerjamesmacleod syndrome associated with. An urgent computed tomography pulmonary angiogram revealed right middle lobe syndrome which constitutes chronic collapse of the middle lobe accompanied by bronchiectatic changes. This is easy to remember as the m iddle l obe has m edial and l ateral segments. Sixteenslice computed tomography scan revealed the middle lobe of right lung was detected atelectasis in lung window because of compression from enlarged esophagus, and upper esophagus expanded obviously figure 1d, lower esophagus and cardia became significantly narrow and mucous membrane around of this area also was thick in soft tissue window. Otherwise, a chronic cough is the most common symptom.
A 32yearold, neversmoker man presented with episodic dyspnoea and wheezing along with cough and mucoid sputum. They described 6 elderly women who were immunocompetent, had no significant smoking history or underlying pulmonary disease, and developed mycobacterium avium complex mac pulmonary infection limited to the right middle lobe or lingula. Pathophysiologically, there are two forms of middle lobe syndrome, namely. A ct scan showing mls with consolidation and atelectasis of the right middle lobe arrow. Early workers indicated that carcinoma rarely originates in the right middle lobe. Mls is an uncommon lung disorder, usually refers to any cause of recurrent or persistent atelectasis of the right middle lobe. Ten years experience in surgical treatment of right middle. Concurrent thymic carcinoma and middle lobe syndrome. A 58yearold female patient presented to the hospital with hearing loss. As the name implies, this lobe is located between the upper and lower also called the superior and inferior lobes. Diagnostic studies included chest roentgenogram, bronchoscopy, and bronchography.
The collapse is not usually associated with airway obstruction. Infectious causes of right middle lobe syndrome moffitt cancer. Although it was first described in 1984 by graham et al. The volume loss resulting from collapse of the right middle lobe is seen as a triangle of increased density between. Surgical options were discussed with the patient, but he declined any intervention. Pulmonary tuberculosis presented with right middle lobe. Thus, diagnosis of swyerjamesmacleod syndrome associated with right lung middle lobe hypoplasia and arteriovenous malformation was made. Right middle lobe rml syndrome is defined as recurrent or chronic obstruction or infection of the middle lobe of the right lung. Right middle lobe syndrome is characterized by a wedgeshaped density that extends. Spontaneous right chylothorax with middle lobe syndrome. 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.
There were 31 male and 67 female patients ranging in age from 4 to 80 years. Ct of the chest revealed consolidation and collapse of the right middle lobe. Surgical treatment of right middle lobe syndrome in children. 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. Reich and johnson first used the term lady windermere syndrome in 1992. This report is unusual on account of a the concomitant. 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. Initially the patient required resuscitation to optimise her haemodynamic parameters while oxygenation remained satisfactory. Intrinsic obstruction of the right middle lobe bronchus 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. Search icd10 code lookup find diagnosis codes icd10cm and procedure codes icd10pcs by disease, condition or icd10 code. Moderate stenosis at the origin of the middle bronchus and discrete collapse of the middle lobe. Surgical treatment of right middle lobe syndrome in. Middle lobe of right lung definition of middle lobe of. Md nexus pulmonary and critical care right middle lobe syndrome.
Excision of the cyst at median sternotomy resulted in complete resolution of all symptoms. A case of upper left extremity deep vein thrombosis with. The most common presenting symptoms were cough, dyspnea, fever, hemoptysis, and chest pain. Middle lobe syndrome is a clinical entity characterized by chronic or recurrent atelectasis of the right middle lung lobe.
Apr 15, 20 middle lobe syndrome mls is an uncommon disease involving the right middle lobe andor left lingula. The chest radiograph was suggestive of a middle lobe syndrome mls. A case of swyerjamesmacleod syndrome associated with middle. Highresolution ct hrct of the chest confirmed the presence of mls. Mar 18, 2015 only the right lung has a middle lobe. May 16, 2018 right middle lobe syndrome rmls generally refers to chronic or recurrent atelectasis in the right middle lobe of the lung. According to several reports, tuberculosis was the most common cause of right middle lobe syndrome in south korea. The middle lobe syndrome occurs more frequently than is generally appreciated. Chronic or recurrent collapse of right middle lobe, so called middle lobe syndrome is common in elderly woman.