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Updated: Aug 16, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
[The middle lobe syndrome in pediatrics. A study of 27 cases]
W Youssef Fasheh1, G Esquinas Rychen
1Unitat Integrada Hospital Clinic Sant Joan de Déu, Universidad de Barcelona.
Objective:
The purpose of this study was to analyze the features, treatment and evolution of middle lobe syndrome (MLS) or atelectasis syndrome in children.
Patients And Methods:
Between 1992 and 1996, all cases of MLS seen in our center by our staff were followed by using a prospective study protocol.
Results:
Twenty-seven patients were studied. The average age at the onset of MLS was 3 years 1 month +/- 2 years 4 months. Recurrent pneumonia was seen in 66.7% and 44.4% had asthma and/or elevated IgE. Acute symptoms at the onset were seen in 74% of the cases, with persistent cough being the most common symptom. Complementary procedures (chest X-rays, computed tomography scans, bronchoscopy, V/P scintigraphy) demonstrated 16 cases of pneumonia, 13 of atelectasis, 7 of bronchiectasia and 4 cases with other abnormalities. Infectious etiology was the most predominant (66.7%) Bronchoscopy was performed in 8 cases and 5 of them improved immediately. Pulmonary scintigraphy was normal in those patients with radiographic residual images. All patients were initially medically treated. Three were lobectomized. Twenty-three patients healed. The younger the patient at the onset of MLS the better the cure rate.
Conclusions:
Infectious causes were dominant in our series. Early and aggressive medical treatment may cure the majority of cases. Bronchoscopy is helpful in the diagnosis and as a therapeutic procedure. Scintigraphy could be helpful as a resolution criterion when there are residual radiographic images.
Insights
Middle lobe syndrome (MLS) in children is often caused by infections. Early medical treatment and bronchoscopy can cure most cases, with younger patients having better outcomes.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Pediatric Infectious Diseases
Context:
- Middle lobe syndrome (MLS), also known as right middle lobe syndrome or atelectasis syndrome, is a common condition in pediatric patients.
- Recurrent pneumonia and asthma are frequently associated with MLS in children.
Purpose:
- To analyze the clinical features, treatment strategies, and outcomes of middle lobe syndrome (MLS) in pediatric patients.
- To evaluate the efficacy of medical management and bronchoscopy in treating MLS.
Summary:
- A prospective study of 27 children with MLS revealed infectious etiology in 66.7%. Common symptoms included persistent cough, recurrent pneumonia, and asthma.
- Initial medical treatment was successful in most cases, with 23 out of 27 patients healed. Bronchoscopy provided immediate improvement in 5 of 8 cases.
- Younger age at onset correlated with a better cure rate. Scintigraphy may serve as a resolution criterion for residual radiographic images.
Impact:
- Highlights the predominantly infectious nature of MLS in children.
- Emphasizes the effectiveness of early, aggressive medical intervention and bronchoscopy for favorable outcomes.
- Suggests age as a prognostic factor and scintigraphy as a useful diagnostic tool for assessing resolution.
