Middle Lobe Syndrome

• • 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

Symptoms and Signs

• • Repeated right-sided pneumonias

Rule Out

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

• • Bronchoscopy to rule out endobronchial tumors and foreign bodies

• • Intensive medical therapy usually adequate treatment

Surgery

• • RML lobectomy

Indications

• • Bronchiectasis

  • Fibrosis of RML

  • RML abscess

  • Intractable recurrent pneumonia

  • Suspicion of neoplasm

References