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2.1
Middle Lobe Syndrome
Brock Syndrome

Presentation

A diagnosis of TBA presenting as MLS was made. To the best of our knowledge, this is the first detailed report of MLS as a presentation of TBA in the English literature. [ncbi.nlm.nih.gov]

Entire Body System

  • Collapse

    Abstract Middle lobe syndrome is defined as recurrent or chronic collapse of the middle lobe of the right lung. [ncbi.nlm.nih.gov]

    Convert to ICD-10-CM : 518.0 converts approximately to: 2015/16 ICD-10-CM J98.11 Atelectasis Or: 2015/16 ICD-10-CM J98.19 Other pulmonary collapse Approximate Synonyms Atelectasis Pressure collapse of lung due to OB anesthesia in pregnancy Pressure collapse [icd9data.com]

    See also atelectasis, bronchiectasis. middle lobe syndrome A condition characterised by chronic atelectasis and collapse of the middle lobe and/or lingula of the right lung due to extrinsic compression of the right middle bronchus. [medical-dictionary.thefreedictionary.com]

    Bronchiesctasis can also lead to other complications; in Mike’s case, the partial collapse of his right lung. [bc.lung.ca]

  • Inflammation

    Pathophysiology Certain anatomical characteristics make the right middle lobe susceptible to transient obstruction as a result of inflammation or edema. [emedicine.medscape.com]

    Inflammation in its blind pocket was believed to be the underlying cause of recurrence. [ncbi.nlm.nih.gov]

    The underlying etiology of right middle lobe syndrome remains poorly understood, but poor collateral ventilation, a relatively narrow ostium, and infection/inflammation are all thought to play a role 3. [radiopaedia.org]

  • Lymphadenopathy

    Aetiology Thymoma, hilar lymphadenopathy (e.g., TB, sarcoidosis or lymphoma), tumours or obstruction (due to intraluminal tumours or foreign bodies). [medical-dictionary.thefreedictionary.com]

    Lymphadenopathy was seen in 64% of patients at CT and in 47% at MR imaging. CONCLUSIONS: Patients with middle lobe syndrome show a wide range of parenchymal and bronchial abnormalities at diagnosis. [ncbi.nlm.nih.gov]

    Obstructive pathophysiology is defined when there is an endobronchial lesion or extrinsic compression of the middle lobe bronchus by lymphadenopathy (as in our case) or a tumor. [swjpcc.com]

    […] middle lobe bronchus 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 [mdnxs.com]

  • Foreign Body Aspiration

    The etiologies include broncholithiasis, peribronchial lymphadenopathy, foreign body aspiration, and bronchiectasis. [journals.lww.com]

    Foreign body aspiration into the right middle lobe orifice can also predispose to collapse of the lobe. Epidemiology Frequency United StatesThe precise incidence in children is unknown. [thehealthscience.com]

    Foreign body aspiration into the right middle lobe orifice can also predispose to collapse of the lobe. Epidemiology Frequency United States The precise incidence in children is unknown. [emedicine.medscape.com]

    body aspiration. 1, 2 It has, up to now, not been reported in patients with primary Sjögren’s syndrome, although similar radiological findings have been described in a patient with systemic lupus erythematosus with suspected secondary Sjögren’s syndrome [mja.com.au]

  • Weight Loss

    Case Report An 81-year-old retired schoolteacher presented with cough, shortness of breath, night sweats, and weight loss for ∼1 year that had worsened over the last 1 month. Middle lobe bronchiectasis had been documented by CT 3 years earlier. [academic.oup.com]

    In our study most common symptoms were cough and difficult sputum expectoration followed by weight loss, haemoptysis, chest pain and dyspnea in frequency. [jtd.amegroups.com]

Respiratoric

  • Cough

    Our patient was a retired schoolteacher and considered it impolite to cough in public. She had a lifelong history of suppressing her cough. [academic.oup.com]

    […] middle lobe syndrome mid·dle lobe syn·drome atelectasis with chronic pneumonitis of the middle lobe of the (right) lung, due to compression of the middle lobe bronchus, usually by enlarged lymph nodes, which may be tuberculous; chief symptoms are chronic cough [medical-dictionary.thefreedictionary.com]

    The most common clinical features were recurrent infection (n = 15), chronic cough with productive sputum (n = 9), chest pain (n = 8) or dyspnea (n = 7). [ncbi.nlm.nih.gov]

    (see Cough ) Treatment Early intervention (especially in children) may help to avoid chronic atelectasis or the development of bronchiectasis References Allergic bronchopulmonary aspergillosis with middle lobe syndrome and allergic Aspergillus sinusitis [mdnxs.com]

  • Aspiration

    Fibreoptic bronchoscopy revealed anthracotic pigmentation, and bronchial aspirate showed acid fast bacilli. Culture of the aspirate grew Mycobacterium tuberculosis. The patient responded to standard antituberculous treatment. [ncbi.nlm.nih.gov]

    Prostate Male Anatomy … Wikipedia Pulmonary aspiration — In medicine, aspiration is the entry of secretions or foreign material into the trachea and lungs. [medicine.academic.ru]

  • Chronic Cough

    Middle lobe syndrome, caused mainly by benign inflammatory diseases, such as chronic bronchitis and bronchiectasis, is manifested clinically as a chronic cough with sputum production. [ncbi.nlm.nih.gov]

    […] of the middle lobe of the right lung, characterized by chronic infection, cough, dyspnea, wheezing, and obstructive pneumonitis. [medical-dictionary.thefreedictionary.com]

    Chronic cough. Diagnostic workout: Thoracic X-ray or CT scan. Bronchoscopy. Ventilatory and perfusion scintigraphy. [kidsdoc.at]

  • Hemoptysis

    The most common presenting symptoms were cough, dyspnea, fever, hemoptysis, and chest pain. Diagnostic studies included chest roentgenogram, bronchoscopy, and bronchography. Sixty-five patients had full recovery following intensive medical therapy. [ncbi.nlm.nih.gov]

    […] with chronic pneumonitis of the middle lobe of the (right) lung, due to compression of the middle lobe bronchus, usually by enlarged lymph nodes, which may be tuberculous; chief symptoms are chronic cough, wheezing, recurrent respiratory infections, hemoptysis [medical-dictionary.thefreedictionary.com]

    Hemoptysis, chest pain, and dyspnea are also reported 1. [radiopaedia.org]

  • Pulmonary Disorder

    Morris Lippincott Williams & Wilkins, 2005 - 647 من الصفحات The thoroughly revised, updated Sixth Edition of this Spiral® Manual is a complete, convenient, practical guide to diagnosis and management of pulmonary disorders. [books.google.com]

    […] with predisposing pulmonary disorders (PDPD). [scinapse.io]

Cardiovascular

  • Chest Pain

    The most common presenting symptoms were cough, dyspnea, fever, hemoptysis, and chest pain. Diagnostic studies included chest roentgenogram, bronchoscopy, and bronchography. Sixty-five patients had full recovery following intensive medical therapy. [ncbi.nlm.nih.gov]

    pain, weight loss, and fever. [journals.lww.com]

    In present study, most patients complaint nonspecific symptoms such as dyspnea, chest pain or general weakness, and one patient died of anti-TB drug induced hepatotoxicity. Some authors have reported... [epos.myesr.org]

  • Heart Failure

    This is a frequent occurrence with pleural effusion, caused by congestive heart failure (CHF). [en.wikipedia.org]

    In this series, there were 236 patients who had elective aortic root replacement with no 30-day mortality. 36 patients underwent emergent surgery for aortic dissection and/or end stage heart failure; two of these patients arrived in the operating room [marfan.com.br]

Workup

[…] a chest radiograph is warranted in children with persistent or recurrent nonspecific respiratory symptoms, particularly if there is clinical deterioration, in order to detect middle lobe syndrome and to initiate a further diagnostic and therapeutic workup [ncbi.nlm.nih.gov]

X-Ray

  • Atelectasis

    See also atelectasis, bronchiectasis. middle lobe syndrome A condition characterised by chronic atelectasis and collapse of the middle lobe and/or lingula of the right lung due to extrinsic compression of the right middle bronchus. [medical-dictionary.thefreedictionary.com]

    Middle lobe syndrome - recurrent atelectasis and/or bronchiectasis involving the right middle lobe and/or lingula - has, up to now, not been reported as the pulmonary manifestation of primary Sjögren's syndrome. [ncbi.nlm.nih.gov]

    Background Right middle lobe syndrome (RMLS) generally refers to chronic or recurrent atelectasis in the right middle lobe of the lung. [emedicine.medscape.com]

Treatment

Medical treatment consists of bronchodilators, mucolytics, and antimicrobials. Patients whose disease is unresponsive to treatment and those with obstructive RML syndrome can be offered surgical treatment. [ncbi.nlm.nih.gov]

These patients had completed antituberculous treatment. The patients had been symptomatic for the last 1 to 10 years (mean, 4 years) and had received several medical treatments. [thoracicmedicine.org]

Prognosis

The prognosis associated with this syndrome is considered good in most cases which are caused by chronic inflammatory diseases. A patient who developed lung cancer in the course of long-term treatment for right middle lobe syndrome is described. [ncbi.nlm.nih.gov]

[…] is useful in excluding a cause of bronchial obstruction Middle lobe bronchus enters consolidated lobe in the posteromedial corner Differential Diagnosis Middle lobe pneumonia Treatment Depends on etiology Most are treated with medical therapy alone Prognosis [learningradiology.com]

The course and prognosis of endobronchial TB are variable, ranging from complete clearance to severe bronchostenosis ( 15 ). In this study, clinical, radiological and bronchoscopic characteristics of cases diagnosed to have EBTB were evaluated. [jtd.amegroups.com]

The authors conclude that the prognosis for successful retinal detachment repair in the Marfan Syndrome patients at the Wilmer Eye Institute is good regardless of whether the eye has had prior lens removal. [marfan.com.br]

Etiology

[…] include Inflammatory disease is the most common etiology In children, it is most common in association with asthma Malignant tumors (22%0 Bronchiectasis (15%) Tuberculosis (9%) Benign tumors (2%) In most cases, the etiology is never found Clinical Findings [learningradiology.com]

The etiology of MLS was initially described as external compression of the right middle lobe bronchus. However, it is known that multiple etiologies of MLS exist, involving intrinsic and extrinsic bronchial compression. [journals.lww.com]

Malignancy is the most common cause of the obstructive type, and infections are the second leading etiology. The nonobstructive type is associated with inflammatory conditions and bronchiectasis. [ncbi.nlm.nih.gov]

First described in the medical literature in 1948, [1] it is caused by various etiologies and has no consistent clinical definition. [emedicine.medscape.com]

It is caused by various etiologies and has no consistent clinical definition. [thehealthscience.com]

Epidemiology

Epidemiology Frequency United States The precise incidence in children is unknown. Right middle lobe syndrome is widely underdiagnosed and frequently unrecognized. [emedicine.medscape.com]

Epidemiology Frequency United StatesThe precise incidence in children is unknown. Right middle lobe syndrome is widely underdiagnosed and frequently unrecognized. [thehealthscience.com]

Epidemiology, airway defense mechanisms, pathogenesis, imaging and genetic causes of bronchiectasis are discussed. Allergic bronchopulmonary aspergillosis is addressed, as well as non-tuberculous mycobacteria as a cause of bronchiectasis. [books.google.com]

Pathophysiology

There are two distinct types of pathophysiology- obstructive and non-obstructive. [swjpcc.com]

A lack of collateral ventilation is a plausible theory to explain the pathophysiology in such patients. [ncbi.nlm.nih.gov]

Prevention

This isolation prevents the aerating effects of collateral ventilation of the upper lobe from reaching the middle lobe and thus impairs the clearing of secretions from the middle lobe bronchus. [ncbi.nlm.nih.gov]

Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎ [books.google.es]

B.A., Zhang, L., Villafranca, A., Karl, L., Kamal, S., Torres, B., o'Connor Michael (2011) Prevention of Intraoperative Awareness in a High-Risk Surgical Population. [scindeks.ceon.rs]

Prevention of bacterial endocarditis. ‏ الصفحة 303 - American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. ‏ [books.google.com]

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