Obstructive Lung Diseases: Student/Resident Case Report Poster - Obstructive Lung Diseases |

Middle Lobe Syndrome FREE TO VIEW

Wael Sankar, MD; Natalia Castillo, MD; Hammad Bhatti, MD; Sayed Ali, MD
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UCF, Orlando, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):926A. doi:10.1016/j.chest.2016.08.1026
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SESSION TITLE: Student/Resident Case Report Poster - Obstructive Lung Diseases

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Middle lobe syndrome (MLS) is a rare, but important medical condition that remains poorly defined in the current literature. It can be caused by multiple etiologies and the exact definition and prevalence remains obscure.

CASE PRESENTATION: 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 his chronic asthma. He had been compliant with his appropriate inhalers and had been previously treated with multiple courses of steroids and antibiotics with some improvement. He was afebrile on presentation and his chest examination revealed bilateral wheezing. An initial chest x-ray revealed a right middle lobe consolidation (Figure 1). A CT chest subsequently showed atelectasis of the right middle lobe with air bronchograms (Figure 2). A bronchoscopy was later pursued, showing mild narrowing of the middle lobe bronchus, copious mucus, but no visible endo-bronchial lesion. A PET scan failed to show any areas of increased uptake. He was diagnosed with the non-obstructive MLS causing recurrent asthma exacerbation.

DISCUSSION: MLS is a rare entity that is poorly reported in the literature. It typically occurs in children and asthmatics and despite the name, can occur in other parts of the lung.1 The two forms include, obstructive MLS: caused by some form of intrinsic or extrinsic compression (tumors, hilar nodes), often relieved by appropriate intervention and non-obstructive MLS: where the etiology is poorly understood and no obstruction is evident on CT or during bronchoscopy.1, 2 Non-obstructive MLS often responds well to medical treatment including bronchodilators, mucolytic and antibiotics.1, 2 In some symptomatic patients, typically those who do not respond to conservative treatments, surgical removal of the middle lobe can be considered.1, 2

CONCLUSIONS: Our patient was treated with a combination of bronchodilators, mucolytic and oral antibiotic. At his phone call appointment 1 week later, the patient reported feeling subjectively better. A follow up x-ray continued to show atelectasis of the right middle lobe. Surgical options were discussed with the patient, but he declined any intervention.

Reference #1: Blaivas AJ, Strauss W. Middle lobe syndrome in the left lower lobe in chronic obstructive pulmonary disease. Prim Care Resp J 2009;18(4):331-333

Reference #2: Gudjartsson T, Gudmundsson G. Middle lobe syndrome: a review of the clinicopathological features, diagnosis and treatment. Respiration 2012;84(1):80-6

DISCLOSURE: The following authors have nothing to disclose: Wael Sankar, Natalia Castillo, Hammad Bhatti, Sayed Ali

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