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

Affiliations
  • 1Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India. ashokshah99@yahoo.com

Abstract

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.

Keyword

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

MeSH Terms

Aspergillosis, Allergic Bronchopulmonary*
Asthma
Bronchiectasis
Child
Diagnosis
Female
Humans
Inflation, Economic
Middle Lobe Syndrome*
Prednisolone
Radiography, Thoracic
Prednisolone

Figure

  • 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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