Middle Lobe Syndrome in Children

Atelectasis of the middle lobe or lingula of the lung is defined as middle lobe syndrome. On chest x-ray it is demonstrated as a wedge shaped density with anterior-inferior extension from the hilum. Although many etiologies have been implicated, this syndrome is one of the most common complications of asthma. A simple descriptive study was conducted on 11 patients with an age range of 0-18 yrs. They were admitted to Masih Daneshvari Hospital during 2000-2007 with the diagnosis of lingula or middle lobe atelectasis (of more than one month duration) and / or recurrent consolidation (2 times or more). The study group consisted of 6 boys (54.5%) and 5 girls (45.5%). All patients were clinically symptomatic at the time of admission. Cough was the chief complaint (7patients, 63.6%). The mean age at the time of initial diagnosis was 7.3 yrs (SD: 1.6).The most common findings on pulmonary CT-scan were infiltrations (3 cases, 27.3%) and atelectasis (3 cases, 27.3%). Non-obstructive causes were the most frequent etiologies which included asthma (n=3, 27.3%), pneumonia (n=2, 18.2%) and bronchiectasis (n=2, 18.2%).Among the obstructive causes, an undefined tumor (1 case, 9.1%) was to mention. Nine cases (81.8%) had negative blood cultures and 9 cases (81.8%) had AFB negative sputum smears (3×). Bronchoscopy was performed in 4 (36.4%); which showed rapid improvement after fiberoptic bronchoscopy (FOB). Medical treatment was planned for 9 children who demonstrated quick recovery. Surgery (lobectomy) was conducted in only 1 patient. Patients with right middle lobe syndrome (RMLS) had airway hypersensitivity, which is supported by the fact that asthma is very severe in this group of patients. Despite its low incidence, it should be considered very carefully and cautiously since it is associated with many severe complications. Therefore in undiagnosed suspected cases, in addition to a meticulous history taking, detailed diagnostic and therapeutic measures are recommended.