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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]
  • PURPOSE: Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS.[ncbi.nlm.nih.gov]
  • EBTB presenting as a MLS is a distinct rarity.[ncbi.nlm.nih.gov]
  • We report this rare and unusual clinical presentation in a 36-year-old male, who presented for evaluation of a "non resolving pneumonia". Imaging suggested the presence of a MLS and central bronchiectasis.[ncbi.nlm.nih.gov]
  • The present report describes the case of a 34-year-old woman who presented with chyloptysis associated with recurrent right middle lobe syndrome since she was 20 years of age, and eventually underwent right middle lobectomy.[ncbi.nlm.nih.gov]
Weight Loss
  • Symptom Pediatric right middle lobe syndrome symptoms common symptoms recurrent pneumonia lung atelectasis lymph nodes swollen rales chronic cough weight loss fatigue pus and sputum hemoptysis breath sounds weakened Children from 1 to 2 years old began[healthfrom.com]
  • 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]
Fatigue
  • To avoid excessive fatigue, cold when popular less to public places. 4. Early prevention and treatment of upper respiratory tract infection.[healthfrom.com]
Malaise
  • […] 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, chest pain, malaise[medical-dictionary.thefreedictionary.com]
Amyloidosis
  • Abstract Pulmonary involvement in amyloidosis is a distinct rarity. This clinical entity usually presents as tracheobronchial amyloidosis (TBA).[ncbi.nlm.nih.gov]
Cough
  • 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]
  • It is not clear whether they had a history of habitual cough suppression. 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]
  • 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]
  • The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients.[ncbi.nlm.nih.gov]
  • Abstract 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]
Chronic Cough
  • The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients.[ncbi.nlm.nih.gov]
  • Abstract 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]
  • 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]
  • Chronic cough. Diagnostic workout: Thoracic X-ray or CT scan. Bronchoscopy. Ventilatory and perfusion scintigraphy.[kidsdoc.at]
  • Otherwise, a chronic cough is the most common symptom. Hemoptysis , chest pain, and dyspnea are also reported 1 .[radiopaedia.org]
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]
  • Clinical findings were cough 95%, sputum 80% and intermittent hemoptysis in 50% of patients. Middle lobe collapse was seen in CT scan of all patients. Bronchiectasis was the most common pathologic finding (55%).[ncbi.nlm.nih.gov]
  • Hemoptysis , chest pain, and dyspnea are also reported 1 .[radiopaedia.org]
  • All patients were symptomatic and complained of chronic cough (8), hemoptysis (6), chest pain (4), dyspnea (3), or fever (2).[ncbi.nlm.nih.gov]
  • […] doi: 10.1097/CPM.0b013e3180d09c8f Images in Pulmonary Medicine Abstract In Brief Author Information Authors Article Metrics Metrics Middle lobe syndrome (MLS) commonly presents with chronic cough, right-sided chest pain, purulent sputum, hemoptysis, weight[journals.lww.com]
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]
Chronic Productive Cough
  • CONCLUSION: MLS is more common in females, and recurrent infections, chronic productive cough and dyspnea were the most common symptoms. Bronchiectasis is the most common histological finding.[ncbi.nlm.nih.gov]
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]
  • Abstract A 60-year-old Indian woman who was suffering from recurrent pneumonia presented with major haemoptysis and a right-sided pleuritic chest pain.[ncbi.nlm.nih.gov]
  • The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients.[ncbi.nlm.nih.gov]
  • 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]
  • pain, weight loss, and fever.[journals.lww.com]
Confusion
  • This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion.[ncbi.nlm.nih.gov]
  • Right Middle Lobe Syndrome General Details: Right Middle Lobe Syndrome is a confusing term. There is no consistent clinical definition. Commonly described as non-obstructive atelectasis of the Right Middle Lobe (RML) of lung.[medicalchemy-respiratory.blogspot.com]
  • […] 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, chest pain, malaise, easy fatigability, and loss of weight; sometimes confused[medical-dictionary.thefreedictionary.com]
  • I feel confused. I certainly don't want to submit my daughter to more tests however I don't want to make light of the situation either.[medhelp.org]
Irritability
  • Prompt diagnosis and initiation of medical therapy including the administration of antibiotics and the avoidance of irritating agents may be effective.[ncbi.nlm.nih.gov]

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]
Lymphocytic Infiltrate
  • Histological findings of the resected specimens showed overgrowth of the bronchial glands, lymphocytic infiltration around the alveoli and glandular metaplasia of the alveoli in both cases.[ncbi.nlm.nih.gov]
  • The atelectasis responded well to glucocorticoid treatment, suggesting that the peribronchiolar lymphocytic infiltrates may have played an important role in the development of middle lobe syndrome in this patient.[ncbi.nlm.nih.gov]
  • infiltrating the small airway walls. 7 , 8 Local bronchial or bronchiolar lymphocyte infiltrates and inflammatory cell products may lead to impairment of tracheobronchial mucociliary clearance. 8 , 9 In our patient, lymphocytic infiltrations in the terminal[mja.com.au]

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]
  • OBJECTIVES: The aim of this study is to evaluate the feasibility and safety of video-assisted thoracic surgery (VATS) for the treatment of middle lobe syndrome (MLS) through comparison with thoracotomy during the same period.[ncbi.nlm.nih.gov]
  • The most suggestive symptoms are unresolving/persisting symptoms during admission and/or following treatment.[ncbi.nlm.nih.gov]
  • DESIGN: Children with atelectasis of the RML and/or lingula persisting for 1 month or recurring two or more times despite conventional treatment underwent high-resolution CT (HRCT) scanning and FOB.[ncbi.nlm.nih.gov]
  • (A) treatment Treatment varies according to the cause, including the cause of treatment and symptomatic treatment. 1.[healthfrom.com]

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]
  • In general, surgical indications for timely surgery, postoperative prognosis is good. 1.[healthfrom.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

  • 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]
  • […] 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]
  • However, issues regarding its etiology, clinical presentation, and management continue to puzzle the clinical practitioner. Pathophysiologically, there are two forms of middle lobe syndrome, namely obstructive and nonobstructive.[ncbi.nlm.nih.gov]
  • Abstract A review of the major literature dealing with the middle lobe syndrome shows that benign inflammatory disease is the most common etiological factor (62%), with bronchiectasis responsible for at least a quarter of the patients in these series.[ncbi.nlm.nih.gov]

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]
  • A frontal lobe syndrome can result from a range of causes inlcuding head trauma, tumours,… … Wikipedia Chiasmal syndrome — Contents 1 Anatomy 2 Pathophysiology 3 Etiology and Epidemiology 4 Management 5 References … Wikipedia Cerebellopontine angle syndrome[medicine.academic.ru]
  • المحتويات Complications and Discontinuation 339 Oxygen Therapy and Toxicity 345 ProtocolDriven Care in Respiratory Therapy 351 Epidemiology Natural History 357 Prophylaxis 364 Chronic Thromboembolic Pulmonary Hypertension 375 Unusual Forms of Embolism[books.google.com]
Sex distribution
Age distribution

Pathophysiology

  • A lack of collateral ventilation is a plausible theory to explain the pathophysiology in such patients.[ncbi.nlm.nih.gov]
  • We suggest that ineffective collateral ventilation is a major factor in the pathophysiology of the Middle Lobe Syndrome.[ncbi.nlm.nih.gov]
  • Pathophysiologically, there are two forms of middle lobe syndrome, namely obstructive and nonobstructive.[ncbi.nlm.nih.gov]
  • The original view that bronchial compression was the pathophysiological abnormality leading to development of the syndrome has been rejected by more recent authors.[ncbi.nlm.nih.gov]
  • Pathophysiologically, there are two forms of MLS, namely obstructive and nonobstructive.[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]
  • CONCLUSIONS: Timely medical intervention in patients with MLS that includes FOB with BAL prevents bronchiectasis that may be responsible for an ultimately unfavorable outcome.[ncbi.nlm.nih.gov]
  • Prevention Prevention of middle right lobe syndrome in children For non-specific pneumonia and (or) allergic reactions, acute attack with antibiotics, expectorant, anti-allergy treatment, complete cure infection and inflammation; can prevent pulmonary[healthfrom.com]
  • 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]
  • Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎[books.google.es]

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