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Outcome after right middle lobe syndrome
K De Boeck1, T Willems, D Van Gysel
1Department of Pediatrics, Leuven (Belgium) University Hospital.
Insights
Children diagnosed with right middle lobe syndrome (RMLS) may experience long-term respiratory issues, including asthma and bronchiectasis. Early diagnosis of RMLS in childhood is linked to poorer pulmonary outcomes later in life.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Childhood Lung Disease
Background:
- Long-term pulmonary outcomes of childhood right middle lobe syndrome (RMLS) are not well-established.
- RMLS is characterized by persistent atelectasis of the right middle lobe.
Purpose of the Study:
- To evaluate the long-term pulmonary consequences of RMLS diagnosed in early childhood.
- To identify risk factors associated with persistent respiratory problems after RMLS.
Main Methods:
- A cohort of 17 children diagnosed with RMLS in early childhood was followed up.
- Pulmonary function tests (PFTs), including spirometry and methacholine challenge tests, were performed.
- Radiographic findings and clinical symptoms were assessed at follow-up.
Main Results:
- Five of 17 children (29%) experienced ongoing respiratory problems, including asthma and bronchiectasis.
- Patients with ongoing symptoms showed significantly lower vital capacity and FEV1 compared to controls.
- Lower methacholine provocative dose (PD20) in symptomatic patients indicated increased airway hyperresponsiveness.
- Younger age at initial RMLS diagnosis was associated with a trend towards poorer outcomes.
Conclusions:
- Childhood RMLS can lead to significant long-term pulmonary sequelae, including asthma and bronchiectasis.
- Airway hyperresponsiveness and reduced lung function are common in children with a history of RMLS.
- Early diagnosis and intervention for RMLS may be crucial for improving long-term respiratory health.
Abstract:
The long-term pulmonary consequences of right middle lobe syndrome (RMLS) in childhood are not known. Therefore, outcome was evaluated in 17 children with RMLS diagnosed in early childhood (mean age, 3.3 years; SD, 1.1 year). Mean age at follow-up was 10.1 years (SD, 2.6 years). RMLS was defined as atelectasis of the right middle lobe (RML) of at least 1 month's duration and visible on the lateral view of the chest radiograph as a wedge-shaped density extending from the hilum anteriorly and downward. Seventeen children without personal history of allergy or respiratory tract disease were studied as control group. Five of 17 study group children had ongoing respiratory problems: symptoms of asthma were present in 4 patients, and cylindrical bronchiectasis was present in one patient. Chest radiograph at follow-up was abnormal in six patients. Pulmonary function tests, including mean and SEM for vital capacity (VC) (82% of predicted +/- 7 vs 94% predicted +/- 3), FEV1 (77% of predicted +/- 12 vs 96% of predicted +/- 4) and their ratio (75 +/- 5 vs 85 +/- 3) were significantly lower in patients with ongoing respiratory symptoms than in the control children. The provocative dose causing a 20% decrease in FEV1 (PD20) of methacholine was significantly lower in patients with ongoing symptoms at follow-up than in control children and in patients without symptoms at follow-up (2.8[2.2 to 3.1] vs 4.5[2.2 to 8.8] and 9.2[2.3 to 24] mg/mL; median and P25-75, p < 0.05). Age at initial diagnosis tended to be younger in patients with ongoing symptoms at follow-up (2.3 +/- 0.7 years vs 3.8 +/- 0.4 years; p < 0.08).