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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pneumonia of the middle lobe that had been diagnosed by x-ray in a male patient of 51 years of age did not recede completely despite antibiotic treatment. CT showed a space-occupying growth in the middle lobe of about 1.5 cm size, with consecutive atelectasis. Bronchoscopy revealed a pronounced pattern of tracheobronchopathia osteochondroplastica, but it was not possible to confirm the middle lobe syndrome (Brock's syndrome) by histological examination. A mucoepidermoid carcinoma of the middle lobe was histologically established by thoracotomy besides the tracheobronchopathia osteochondroplastica. 9 months post-operatively there is no pointer to any recurrence or metastasising.
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PMID:[Tracheobronchopathia osteochondroplastica and coexistent mucoepidermoid carcinoma of the lung: Case report]. 154 57

Right middle lobe syndrome (RMLS) is characterized by a spectrum of diseases from recurrent atelectasis and pneumonitis to bronchiectasis of the middle lobe. It has been described among all age groups, although the diagnosis in pediatrics may be delayed or missed because of non-specific symptoms or findings. Twenty-one children with RMLS were evaluated during the past 10 years with particular attention to the history, bronchoscopic and pathologic findings. Most of these patients had asthma or a family history of atopic disorders; 3 patients had a family history of RMLS. Only two of the 21 patients had sufficient obstruction on bronchoscopy to account for their disease. Four had evidence of concomitant laryngeal pathology. The various theories of pathogenesis are discussed. In this series, the non-obstructive (impaired collateral ventilation) theory appeared to be most plausible. Bronchoscopy was performed in all instances to rule out obstruction due to foreign body or tumor. It was therapeutic in two-thirds of the cases. Resolution occurred promptly in one-third, and eventually in another third. Of the remaining patients, 4 required lobectomy and were cured; two have decreased but persistent symptoms. An aggressive medical management following bronchoscopy is warranted in all cases, especially when there is a possibility of asthma.
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PMID:Right middle lobe syndrome in children. 362 6

Classically, the middle lobe syndrome has been described as being caused by a central obstruction. Clinical records and radiologic findings were reviewed in 129 patients examined between 1955-1981 who had chronic disease in the right middle lobe and/or lingula. Fifty-eight patients (45%) had no evidence of a central obstructive lesion. The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients. Pathologic study showed varying degrees of chronic inflammation, pneumonia, and bronchiectasis. Surgical results were excellent in isolated disease. Chronic atelectasis and pneumonitis of the right middle lobe and/or lingula do not always imply central obstruction. A lack of collateral ventilation is a plausible theory to explain the pathophysiology in such patients.
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PMID:Peripheral middle lobe syndrome. 661 25

During the last 10 years the pathological substrate of the middle lobe syndrome was analysed in 60 surgically cured cases aged 7-59: there were 36 lung chronic suppurations, 20 neoplasias and 4 tuberculoses. In all these cases it was shown that, together with the specific lesions (infectious, tuberculosis, neoplastic) of bronchial walls and lung parenchyma a more or less obvious and high bronchial obstruction developed leading to obstructive pneumonitis with intralobular lipospongiocytosis. Investigated at different evolutive phases, this pneumonitis led to an extended restructuring of the lung tissue which occupied differently sized areas of the middle lobe. In the neoplastic and tuberculous cases, the restructured lung areas often included neoplastic emboli or infiltrations of neoplastic cells, or, respectively, remnant, reshuffled tuberculous lesions. None of cases presented zones of pure atelectasis.
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PMID:Pathology of the middle lobe syndromes. A histopathological and pathogenetic analysis of sixty surgically-cured cases. 698 93

Middle lobe syndrome (MLS) is an uncommon lung disorder involving the right middle lobe and/or lingula and is characterized by a spectrum of clinical and pathological lesions ranging from recurrent atelectasis or pneumonias to bronchiectasis. Despite several series reporting the clinical features of MLS, histopathological descriptions are rare. We reviewed the clinical characteristics and pathological findings in 21 patients with MLS who underwent surgical resections. Six male and 15 female patients between the ages of 5 and 80 years (mean, 47 years) were studied. All patients were symptomatic and complained of chronic cough (8), hemoptysis (6), chest pain (4), dyspnea (3), or fever (2). The right middle lobe was involved in 11 patients, the lingula in four patients, and both right middle lobe and lingula in six patients. Chest radiographs, bronchograms, and/or computed tomography scans were available for review in 19 patients and showed consolidation (8), bronchiectasis (9), patchy infiltrates (5), and atelectasis (4) in various combinations. Pathological findings included bronchiectasis in 10 patients, chronic bronchitis/bronchiolitis with lymphoid hyperplasia in seven, patchy organizing pneumonia in six, atelectasis in five, granulomatous inflammation in five, and abscess formation in four. Three patients with granulomatous inflammation had associated atypical mycobacterial infection. Broncholithiasis was confirmed by pathological examination in one patient. No pathological cause for bronchial obstruction was identified in the remaining 20 patients, although one was thought to have had broncholithiasis on the basis of preoperative bronchoscopy. The presence of bronchiectasis, bronchitis or bronchiolitis, organizing pneumonia, or atelectasis in specimens from the right middle lobe or of lingula in the absence of an identifiable cause of bronchial obstruction should suggest a diagnosis of MLS.
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PMID:Middle lobe syndrome: a clinicopathological study of 21 patients. 789 Feb 82

236 cases with middle lobe syndrome were examined with fibrobronchoscope. The total rate of positive finding was 92.8% (219/236). Inflammation (167 cases), lung cancer (47 cases), tuberculosis (17 cases) accounted for most of the cases. The diagnostic rate for the three above-mentioned diseases were 97.6%, 87.2% and 58.8% respectively. Fibrobronchoscopy was also of significant diagnostic value in determining other uncommon cases such as broncholithiasis, lipoid pneumonia, lung infiltration in leukemia, etc. The etiology, chest X-ray (including CT) presentations of this middle lobe syndrome and the diagnostic value of fibrobronchoscopy were discussed. Our experience suggests that this procedure is both safe and effective in the diagnosis of patients with middle lobe syndrome.
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PMID:[Fibrobronchoscopy in the diagnosis of middle lobe syndrome]. 817 89

Bacterial (including intracellular pathogens) and mainly viral pneumonia can lead to middle and long term pulmonary sequelae in children with or without underlying disease, namely chronic atelectasis (right middle lobe syndrome), bronchiectasis, obliterative bronchiolitis, unilateral hyperlucent lung syndrome, fibrosis, and peumatoceles. Functional alterations may also be observed, such as bronchial hyperreactivity, chronic cough and asthma. Additionally a relationship between pneumonia in early childhood and the further occurrence of chronic obstructive pulmonary disease in adult life is now admitted. The occurrence of sequelae being usually unpredictable, and a careful assessment of the clinical and radiological outcome is important. The unusual persistence of either respiratory symptoms or radiological alterations justifies investigations such as tomodensitometry and the evaluation of lung function, to look for complications or underlying diseases and, whenever it is possible, to set up an adapted treatment.
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PMID:[Medium and long-term sequelae of community-acquired pneumonia in children]. 1022 62

Primary pulmonary malignant lymphoma is a rare disease that is thought to belong to a category of malignant lymphomas arising from mucosa-associated lymphoid tissue (MALT). We presented 2 cases of MALT lymphoma. Case 1: In a 39-year-old woman, an abnormal shadow was detected in chest radiography in the left S3. The diagnosis was organizing pneumonia in consequence of the further examination. One year after an growing abnormal shadow was detected again, we performed the tumor resection with the thoracoscopy in the possibility of malignancy. The pathological diagnosis was MALT lymphoma. Case 2: In a 70-year-old man, middle lobe syndrome was detected in chest radiography. As a result of the bronchial biopsy, the lesion was suspected of MALT lymphoma. Right middle lobectomy was performed, and the tumor was diagnosed as a MALT lymphoma histologically. He underwent an effective postoperative radiotherapy and has had no evidence of recurrence.
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PMID:[Mucosa-associated lymphoid tissue lymphoma; report of two cases]. 1473 3

Middle lobe syndrome (MLS) is a rare but important clinical entity that has been poorly defined in the literature. It is characterized by recurrent or chronic collapse of the middle lobe of the right lung but can also involve the lingula of the left lung. Pathophysiologically, there are two forms of MLS, namely obstructive and nonobstructive. Obstructive MLS is usually caused by endobronchial lesions or extrinsic compression of the middle lobe bronchus such as from hilar lymphadenopathy or tumors of neoplastic origin, resulting in postobstructive atelectasis and pneumonitis. In the nonobstructive type, no obstruction of the middle lobe bronchus is evident during bronchoscopy or with computerized tomography of the chest. The etiology of the nonobstructive form is not completely understood. Inefficient collateral ventilation, infection and inflammation in the middle lobe or lingula are thought to play a role, and bronchiectasis is the most common histological finding. Patients with proven endobronchial lesions or malignancy are usually offered surgical resection directly. This contrasts with nonobstructive MLS, where most patients respond to medical treatment consisting of bronchodilators, mucolytics and broad-spectrum antibiotics. However, some patients do not respond to conservative treatment and may suffer irreversible damage of the middle lobe or lingula, in addition to having recurrent symptoms of infection or inflammation. These selected patients can be offered surgical resection of the middle lobe or lingula, which is associated with a low mortality rate and favorable outcome.
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PMID:Middle lobe syndrome: a review of clinicopathological features, diagnosis and treatment. 2237 66

Middle lobe syndrome in children is a distinct clinical and radiographic entity that has been well described in the pediatric literature. However, issues regarding its etiology, clinical presentation, and management continue to puzzle the clinical practitioner. Pathophysiologically, there are two forms of middle lobe syndrome, namely obstructive and nonobstructive. Middle lobe syndrome may present as symptomatic or asymptomatic, as persistent or recurrent atelectasis, or as pneumonitis or bronchiectasis of the middle lobe and/or lingula. A lower threshold of performing a chest radiograph is warranted in children with persistent or recurrent nonspecific respiratory symptoms, particularly if there is clinical deterioration, in order to detect middle lobe syndrome and to initiate a further diagnostic and therapeutic workup.
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PMID:Middle lobe syndrome in children today. 2463 Jul 79


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