Tuberc Respir Dis.  2007 Mar;62(3):192-196. 10.4046/trd.2007.62.3.192.

Causes of Right Middle Lobe Syndrome: Recent Experience in Local Tertiary Hospital for Several Years

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea. hochkim@gshp.gsnu.ac.kr
  • 2Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University, Jinju, Korea.

Abstract

BACKGROUND: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. METHOD: Eighty-eight patients (M:F=64:22, mean age: 67.2+/-10.3 years), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed.
RESULTS
The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%).
CONCLUSION
Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common.

Keyword

Right middle lobe syndrome; Causes

MeSH Terms

Bronchiectasis
Bronchoscopy
Constriction, Pathologic
Cough
Dyspnea
Edema
Humans
Korea
Lung Neoplasms
Middle Lobe Syndrome*
Mucus
Pigmentation
Pneumonia
Pulmonary Atelectasis
Radiography
Retrospective Studies
Sputum
Tertiary Care Centers*
Thorax
Tuberculosis
Tuberculosis, Pulmonary

Cited by  1 articles

Right middle lobe syndrome caused by eosinophilic mucoid impaction in adults
Ha Won Hwang, Joo-Hee Kim, Suk Yeon Kim, Sun Ho Lee, Soo Haeng Lee, Sunghoon Park, Yong Il Hwang, Seung Hun Jang, Ki-Suck Jung, In Jae Lee
Allergy Asthma Respir Dis. 2016;4(2):149-153.    doi: 10.4168/aard.2016.4.2.149.


Reference

1. Gudmundsson G, Gross TJ. Middle lobe syndrome. Am Fam Physician. 1996. 53:2547–2550.
2. Wagner RB, Johnston MR. Middle lobe syndrome. Ann Thorac Surg. 1983. 35:679–686.
3. Bertelsen S, Struve-Christensen E, Aasted A, Sparup J. Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment of the so-called middle lobe syndrome. Thorax. 1980. 35:449–452.
4. Saha SP, Mayo P, Long GA, McElvein RB. Middle lobe syndrome: diagnosis and management. Ann Thorac Surg. 1982. 33:28–31.
5. Kwon KY, Myers JL, Swensen SJ, Colby TV. Middle lobe syndrome: a clinicopathological study of 21 patients. Hum Pathol. 1995. 26:302–307.
6. Jang SH, Kim KH, Kim SK, Lee WY, Lee UY, Sohn HY, et al. Clinical study of middle lobe syndrome: a review of 38 cases. Korean J Intern Med. 1984. 27:1452–1457.
7. Kim HJ, Ma SD, Kim EB, Jang KS, Rhu NS, Cho DI, et al. A clinical study of middle lobe syndrome. Tuberc Respir Dis. 1988. 35:194–199.
8. Lee NH, Lee HL, Kim SK, Chang JK, Sung SK, Lee WY. Chest computerized tomographic scan and flexible fiberopticbronchoscopy in the diagnosis of middle lobe syndrome. Tuberc Respir Dis. 1992. 39:236–241.
9. Sin PJ, Lee WY, Kim ST, Yong ST, Sin GC. A Clinical review of middle lobe syndrome. Tuberc Respir Dis abstract. 2001. 151.
10. Lee HS, Maeng JH, Park PG, Jang JG, Park W, Ryu DS, et al. Clinical features of simple bronchial anthracofibrosis which is not associated with tuberculosis. Tuberc Respir Dis. 2002. 53:510–518.
11. Kimoto T, Kawamura T, Nakahara Y, Mochizuki Y. Evaluation of middle lobe syndrome: bronchial washing cultures testing positive for Mycobacterium avium complex. Kekkaku. 1997. 72:61–65.
12. Iwata M, Ida M, Takeuchi E, Nakamura Y, Horiguchi T, Sato A. Middle lobe syndrome: incidence and relationship to atypical mycobacterial pulmonary disease. Nihon Kyobu Shikkan Gakkai Zasshi. 1996. 34:57–62.
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