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Peripheral middle lobe syndrome.

S A Rosenbloom, C E Ravin, C E Putman

    Radiology
    |October 1, 1983
    PubMed
    Summary
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    Chronic right middle lobe and lingula disease in 45% of patients lacked central obstruction. This suggests alternative causes beyond blockages for these lung conditions.

    Area of Science:

    • Pulmonary Medicine
    • Thoracic Surgery

    Background:

    • The middle lobe syndrome is traditionally attributed to central airway obstruction.
    • However, non-obstructive causes may also lead to chronic lung disease in the right middle lobe and lingula.

    Purpose of the Study:

    • To investigate the underlying causes of chronic disease in the right middle lobe and/or lingula.
    • To determine the frequency of central obstruction in these cases and explore alternative pathophysiological mechanisms.

    Main Methods:

    • Retrospective review of clinical records and radiologic findings in 129 patients with chronic disease in the right middle lobe and/or lingula between 1955-1981.
    • Bronchoscopic and radiologic evaluations were used to exclude central obstructive lesions.
    • Surgical confirmation and pathological studies were performed in a subset of patients.

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    Main Results:

    • Fifty-eight patients (45%) showed no evidence of a central obstructive lesion.
    • The majority of affected patients were middle-aged women presenting with chronic cough and chest pain.
    • Pathological findings included chronic inflammation, pneumonia, and bronchiectasis; surgical outcomes were excellent for isolated disease.

    Conclusions:

    • Chronic atelectasis and pneumonitis of the right middle lobe and/or lingula do not invariably result from central obstruction.
    • A lack of collateral ventilation is proposed as a potential pathophysiological mechanism for these non-obstructive cases.