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| CHEST IMAGE |
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| Year : 2018 | Volume
: 6
| Issue : 2 | Page : 86-87 |
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Middle Lobe Syndrome
Amit Panjwani1, Thuraya Zaid2
1 Salmaniya Medical Complex, Manama, Busaiteen; Royal College of Surgeons in Ireland Medical, University of Bahrain, Busaiteen, Kingdom of Bahrain
2 Salmaniya Medical Complex, Manama, Busaiteen, Kingdom of Bahrain
| Date of Web Publication | 10-Jul-2018 |
Correspondence Address:
Amit Panjwani
Department of Internal Medicine (Pulmonary Medicine Unit), Salmaniya Medical Complex, Manama
Kingdom of Bahrain
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jacp.jacp_3_18
How to cite this article:
Panjwani A, Zaid T. Middle Lobe Syndrome. J Assoc Chest Physicians 2018;6:86-7 |
A 34-year-old Ethiopian woman presented to the Department of Internal Medicine (Pulmonary Medicine Unit), Salmaniya Medical Complex, Kingdom of Bahrain in August 2016 with productive cough, fever, and a weight loss of 4 kg over 2 months. The relevant positive clinical findings were pyrexia (38.5°C) and monophonic rhonchi, which was heard in the right mammary area. A contrast-enhanced computed tomography (CT) of the chest revealed consolidation and collapse of the right middle lobe [[Figure 1]a]. Bilateral multiple lung nodules and mild right-sided pleural effusion were seen [[Figure 1]b] along with enlarged mediastinal lymph nodes in the right lower paratracheal, hilar, and subcarinal areas. The middle lobe bronchus was almost completely obstructed by the right hilar lymph node [[Figure 1]c]. Fiberoptic bronchoscopy showed a narrowing of the right bronchus intermedius while the middle lobe bronchus opening was significantly constricted [Figure 2]. A CT-guided biopsy of the consolidation of right middle lobe showed features of non-small-cell lung cancer. A diagnosis of middle lobe syndrome (MLS) secondary to bronchogenic carcinoma was made. It is an uncommon but important clinical condition characterized by recurrent or chronic collapse of the middle lobe in the right lung. It may be either obstructive or nonobstructive. Obstructive MLS occurs due to the endobronchial lesions or due to the extrinsic compression of the middle lobe bronchus by peribronchial lymph nodes and tumors. She was initiated on a cisplatin-based chemotherapy and has been kept under follow-up. | Figure 1: (a) The contrast-enhanced computed tomography (CT) of the chest revealed consolidation and collapse of the right middle lobe. (b) Bilateral multiple lung nodules and mild right-sided pleural effusion were seen. (c) The middle lobe bronchus was almost completely obstructed by the right hilar lymph node
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 | Figure 2: Fiberoptic bronchoscopy showed a narrowing of the right bronchus intermedius while the middle lobe bronchus opening was significantly constricted
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| Declaration of patient consent | |  |
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2]
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