Asia Pac Allergy.  2016 Jan;6(1):67-69. 10.5415/apallergy.2016.6.1.67.

Childhood allergic bronchopulmonary aspergillosis presenting as a middle lobe syndrome

  • 1Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India.


Allergic bronchopulmonary aspergillosis (ABPA) is infrequently documented in children with asthma. Although collapse is not uncommon, middle lobe syndrome (MLS) as a presentation of ABPA is rather a rarity. A 9-year-old female child with asthma presented with increase in intensity of symptoms along with a right midzone patchy consolidation on a chest radiograph. In addition, an ill-defined opacity abutting the right cardiac border with loss of cardiac silhouette was noted. A right lateral view confirmed a MLS, which was further corroborated by high resolution computed tomography. Central bronchiectasis was also observed, which prompted a work-up for ABPA. The child met 7/8 major diagnostic criteria for ABPA. She was then initiated on oral prednisolone that resulted in a marked clinical improvement within a fortnight. Radiological clearance occurred at 3 months with inflation of the middle lobe. ABPA presenting with MLS in a child is yet to be reported. A high index of suspicion is required to establish the diagnosis of ABPA in a child presenting with MLS. This would obviate the invasive investigations usually done to ascertain the cause of MLS.


Allergic Bronchopulmonary Aspergillosis; Asthma; Central Bronchiectasis; Middle Lobe Syndrome; Paediatrics

MeSH Terms

Aspergillosis, Allergic Bronchopulmonary*
Inflation, Economic
Middle Lobe Syndrome*
Radiography, Thoracic


  • Fig. 1 (A) Chest radiograph posteroanterior view showing a right midzone patchy consolidation and an ill-defined opacity abutting the right cardiac border with loss of cardiac silhouette. (B) Chest radiograph right lateral view showing a wedge shaped density extending from the hilum anteriorly and inferiorly along with loss of volume confirming a middle lobe syndrome.

  • Fig. 2 (A) High resolution computed tomography (HRCT) (mediastinal window) of the thorax showing middle lobe syndrome. (B) HRCT (lung window) of the thorax showing central bronchiectasis.

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