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  • • Relapsing lateral pneumonia of right middle pulmonary lobe (RML) caused by intermittent obstruction

    • Obstruction most often extrinsic

    • Consider diagnosis with repeated right-sided pneumonia

    • May be caused by compression/erosion of bronchus by adjacent diseased lymph nodes

    • Poor natural drainage and lack of collateral ventilation explain frequency of involvement of RML

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Symptoms and Signs

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  • • Repeated right-sided pneumonias

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Rule Out

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  • • Other causes of obstruction (neoplasm, foreign body)

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  • • Bronchoscopy to rule out endobronchial tumors and foreign bodies

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  • • Intensive medical therapy usually adequate treatment

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Surgery

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  • • RML lobectomy

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Indications

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  • • Bronchiectasis

    • Fibrosis of RML

    • RML abscess

    • Intractable recurrent pneumonia

    • Suspicion of neoplasm

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References

Ring-Mrozik E et al. Clinical findings in middle lobe syndrome and other processes of pulmonary shrinkage in children (atelectasis syndrome). Eur J Pediatr Surg. 1991;1:266.  [PubMed: 1747357]

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