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Middle Lobe Syndrome

Brock Syndrome


Presentation

  • To our knowledge, this is the first detailed description of lepidic adenocarcinoma and BAF presenting as MLS.[ncbi.nlm.nih.gov]
Mediastinal Lymphadenopathy
  • Hilar and mediastinal lymphadenopathies were assessed on CT and MR images. RESULTS: Baseline CT detected consolidations in 100% of patients, bronchiectases in 35%, bronchial wall thickening in 53% and mucous plugging in 35%.[ncbi.nlm.nih.gov]
  • A computed tomography scan of the chest revealed significant narrowing of the right middle lobe bronchus with partial atelectasis and prominent calcified mediastinal lymphadenopathy (Figure 2).[swjpcc.com]
  • Investigation CT Chest right middle lobe bronchial thickening with distal collapse hilar mediastinallymphadenopathy with suspicion of malignancy 7. InvestBronchscopy 8. Brochoscopy 9.[slideshare.net]
  • A computed tomography (CT) scan of the chest showed inhomogeneous opacities, as well as dilated airways crowded in the medial segment of the right middle lobe and inferior segment of the lingula, without mediastinal lymphadenopathy ( Box, B ).[mja.com.au]
Lymphadenopathy
  • 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]
  • Aetiology Thymoma, hilar lymphadenopathy (e.g., TB, sarcoidosis or lymphoma), tumours or obstruction (due to intraluminal tumours or foreign bodies).[medical-dictionary.thefreedictionary.com]
  • The authors pointed out that any inflammatory process leading to lobar hilar lymphadenopathy may result in bronchostenosis, with consequent atelectasis and pneumonitis.[nejm.org]
  • Investigation CT Chest right middle lobe bronchial thickening with distal collapse hilar mediastinal lymphadenopathy with suspicion of malignancy 7. InvestBronchscopy 8. Brochoscopy 9.[slideshare.net]
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]
Recurrent Infection
  • 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]
  • Symptoms of RMLS include chronic or recurrent cough, dyspnea, wheezing and recurrent infections.[swjpcc.com]
  • If however, this area becomes the site of recurrent infection, the RML may eventually have to be removed. Atelectasis is an area of the lung that has collapsed so that it is not receiving air. This can be a part of RML syndrome.[medhelp.org]
Recurrent Respiratory Infections
  • Most patients presented with recurrent respiratory infection 15/17 (88.2%). The lag time before referral to surgery ranged from 3 to 48 months, mean 17.59 13.1 months. Radiological signs of bronchiectasis were found in 11 (64.7%) patients.[ncbi.nlm.nih.gov]
  • respiratory infections, hemoptysis, chest pain, malaise, easy fatigability, and loss of weight; sometimes confused with interlobar accumulation of fluid in the lateral x-ray view. middle lobe syndrome localized atelectasis of the middle lobe of the right[medical-dictionary.thefreedictionary.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]
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]
  • 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]
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]
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]
  • Hemoptysis, chest pain, and dyspnea are also reported 1.[radiopaedia.org]
  • […] 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]
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]
  • 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]
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]
  • 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]
Xerostomia
  • Primary Sjögren’s syndrome had been diagnosed in 2002, based on the presence of xerostomia, keratoconjunctivitis sicca, anti-Ro/La antibody, and rheumatoid factor, as well as a positive Schirmer’s test and the results of sialoscintigraphy.[mja.com.au]
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]
Bone Pain
  • A 63-year-old woman was admitted to our hospital with complaints of right iliac bone pain. She had been treated for chronic bronchitis and bronchiectasis associated with middle lobe syndrome for 16 years before admission.[ncbi.nlm.nih.gov]
Night Sweats
  • We present a case of a 38-year-old Korean female with a remote medical history significant for pulmonary tuberculosis, who presented for evaluation of an enlarging right hilar mass with associated productive cough, chills, night sweats, right-sided pleuritic[journals.lww.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]
Hyperpigmentation
  • Fiberoptic bronchoscopy visualised bluish-black hyperpigmentation with narrowing and distortion of right middle lobe bronchus suggestive of BAF. Transbronchial biopsy confirmed presence of lepidic adenocarcinoma.[ncbi.nlm.nih.gov]
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
  • 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]

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]
  • 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]
  • 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]
  • First described in the medical literature in 1948, [1] it is caused by various etiologies and has no consistent clinical definition.[emedicine.medscape.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]
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]
  • There are two distinct types of pathophysiology- obstructive and non-obstructive.[swjpcc.com]

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]
  • 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]
  • 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]

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