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1.
Tunis Med ; 101(4): 460-462, 2023 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38372529

RESUMO

Middle lobe syndrome is a rare but important clinical entity worth investigating in local obstructive or inflammatory cause. One of its rare etiologies is broncholithiasis. We report the observation of a young female patient who presented with recurrent hemoptysis. Chest CT scan showed atelectasis of the middle lobe and suggested the diagnosis of broncholithiasis by objectifying, within the collapsed lobe, a calcification located in the bronchial lumen. Bronchial fibroscopy was of little help. Recurrent hemoptysis and doubt about pulmonary neoplasia led to a diagnostic and therapeutic lobectomy. In front of MLS, broncholithiasis should be suspected in the presence of calcifications on imaging. Surgery may be required in case of uncertain cases to not ignore an underlying tumor.


Assuntos
Broncopatias , Calcinose , Litíase , Síndrome do Lobo Médio , Humanos , Feminino , Síndrome do Lobo Médio/etiologia , Síndrome do Lobo Médio/complicações , Hemoptise/etiologia , Broncopatias/diagnóstico , Broncopatias/etiologia , Broncopatias/cirurgia , Litíase/complicações , Litíase/diagnóstico , Litíase/cirurgia , Pulmão/patologia , Calcinose/complicações , Calcinose/diagnóstico
2.
BMJ Case Rep ; 20172017 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-28536221

RESUMO

Pulmonary involvement in amyloidosis is a distinct rarity. This clinical entity usually presents as tracheobronchial amyloidosis (TBA). A 32-year-old, never-smoker man presented with episodic dyspnoea and wheezing along with cough and mucoid sputum. The chest radiograph was suggestive of a middle lobe syndrome (MLS). High-resolution CT (HRCT) of the chest confirmed the presence of MLS. In addition, HRCT showed circumferential thickening of the trachea and the main bronchi, with thickening of the posterior membranous wall of trachea. Fibrebronchoscopy, done to evaluate MLS, visualised multiple small polypoidal lesions in the lower part of trachea and carina. Endobronchial biopsies showed homogeneous, acellular amorphous deposit in the subepithelial region, which was congophilic in nature. A diagnosis of TBA presenting as MLS was made. To the best of our knowledge, this is the first detailed report of MLS as a presentation of TBA in the English literature.


Assuntos
Síndrome do Lobo Médio/diagnóstico , Adulto , Amiloidose/etiologia , Broncopatias/etiologia , Humanos , Masculino , Síndrome do Lobo Médio/complicações , Doenças da Traqueia/etiologia
4.
Ann Thorac Cardiovasc Surg ; 21(4): 354-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25753209

RESUMO

PURPOSE: In this study we present the clinical, radiological, pathological, bronchoscopic and surgical results of 40 patients with diagnosis of middle lobe syndrome who were referred to our thoracic surgery unit for surgical intervention in a 10 years period. METHODS: Forty patients with obstructive and non-obstructive causes of middle lobe syndrome referred to our thoracic surgery unit. Clinical data were collected from the patients' records in a ten years period. This study evaluates diagnostic approaches and surgical treatments in right middle lobe syndrome. RESULTS: We studied 23 females (57.5%) and 17 males (42.5%) with a mean age of 31.7. Clinical findings were cough 95%, sputum 80% and intermittent hemoptysis in 50% of patients. Middle lobe collapse was seen in CT scan of all patients. Bronchiectasis was the most common pathologic finding (55%). Tuberculosis was not rare and was final pathology in 20% of patients. In three patients ruptured hydatid cyst was final finding. Surgery was done without mortality and with only minor complications. CONCLUSION: Lobectomy of right middle lobe is a good therapeutic option in these patients. Due to high prevalence of tuberculosis and hydatid cyst in Middle Eastern countries these two must be considered as causes of middle lobe syndrome.


Assuntos
Síndrome do Lobo Médio/diagnóstico , Síndrome do Lobo Médio/cirurgia , Pneumonectomia , Adulto , Bronquiectasia/etiologia , Tosse/etiologia , Feminino , Seguimentos , Hemoptise/etiologia , Humanos , Irã (Geográfico) , Masculino , Síndrome do Lobo Médio/complicações , Dor/etiologia , Pneumonectomia/métodos , Estudos Retrospectivos , Fatores de Risco , Escarro/metabolismo , Resultado do Tratamento
5.
J Cardiothorac Surg ; 8: 84, 2013 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-23587098

RESUMO

A 60-year-old Indian woman who was suffering from recurrent pneumonia presented with major haemoptysis and a right-sided pleuritic chest pain. Initially the patient required resuscitation to optimise her haemodynamic parameters while oxygenation remained satisfactory. An urgent computed tomography pulmonary angiogram revealed right middle lobe syndrome which constitutes chronic collapse of the middle lobe accompanied by bronchiectatic changes. Angiography identified an abnormal bronchial artery and venous shunting which was embolised satisfactorily. Subsequently she underwent bronchoscopy which was unremarkable. Her post-operative course was uneventful and patient was discharged home. During the post-operative follow-up patient remained stable and was discharged from out-patient clinic after two years.


Assuntos
Hemoptise/complicações , Síndrome do Lobo Médio/complicações , Artérias Brônquicas/anormalidades , Dor no Peito/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia/complicações
7.
Can Respir J ; 16(2): e1-2, 2009.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-19399303

RESUMO

Chyloptysis, in the context of middle lobe syndrome, and chylothorax are rare clinical entities. They are reported in the medical literature mostly as case reports, but never together in the same patient. The present report describes the case of a 34-year-old woman who presented with chyloptysis associated with recurrent right middle lobe syndrome since she was 20 years of age, and eventually underwent right middle lobectomy. A few weeks postoperatively, she developed a right-sided chylothorax, which was refractory to medical therapy, and was successfully treated with thoracic duct ligation. She has been symptom-free for two years postsurgery.


Assuntos
Quilo/metabolismo , Quilotórax/complicações , Síndrome do Lobo Médio/complicações , Síndrome do Lobo Médio/metabolismo , Escarro/metabolismo , Adulto , Quilotórax/cirurgia , Feminino , Humanos , Ligadura , Síndrome do Lobo Médio/cirurgia , Ducto Torácico/cirurgia , Resultado do Tratamento
9.
Anticancer Res ; 26(3B): 2213-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16821589

RESUMO

Middle lobe syndrome, caused mainly by benign inflammatory diseases, such as chronic bronchitis and bronchiectasis, is manifested clinically as a chronic cough with sputum production. The prognosis associated with this syndrome is considered good in most cases which are caused by chronic inflammatory diseases. A patient who developed lung cancer in the course of long-term treatment for right middle lobe syndrome is described. A 63-year-old woman was admitted to our hospital with complaints of right iliac bone pain. She had been treated for chronic bronchitis and bronchiectasis associated with middle lobe syndrome for 16 years before admission. Work-up of a lung adenocarcinoma originating from the right middle lobe disclosed bone metastasis to the illium. Tumorigenesis in association with middle lobe syndrome has not yet been reported, but this first reported case suggests the need to be alert to the possibility.


Assuntos
Neoplasias Pulmonares/complicações , Síndrome do Lobo Médio/complicações , Doença Crônica , Feminino , Humanos , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Síndrome do Lobo Médio/patologia
10.
Chest ; 128(4): 2504-10, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16236916

RESUMO

STUDY OBJECTIVES: Middle lobe syndrome (MLS) in children is characterized by a spectrum of clinical and radiographic presentations, from persistent or recurrent atelectasis to pneumonitis and bronchiectasis of the right middle lobe (RML) and/or lingula. This study was undertaken to evaluate the effect of early intervention, including fiberoptic bronchoscopy (FOB), in the development of bronchiectasis in MLS. DESIGN: Children with atelectasis of the RML and/or lingula persisting for > 1 month or recurring two or more times despite conventional treatment underwent high-resolution CT (HRCT) scanning and FOB. Appropriate treatment and follow-up were provided, and the effect of the duration of symptoms on clinical outcome and the development of bronchiectasis was investigated. The patient cohort was retrospectively reviewed. PATIENTS: We evaluated 55 children with MLS. The median age at diagnosis, duration of symptoms, and duration of clinical deterioration before diagnosis were 5.5 years (range, 3 months to 12 years), 14.5 months (range, 3 to 48 months), and 8 months (range, 3 to 36 months), respectively. MEASUREMENTS AND RESULTS: FOB revealed marked obstruction in two children (ie, a foreign body and an endobronchial tumor) and positive findings for a culture of BAL fluid in 49.1% of patients. The remaining 53 patients were followed up for a median duration of 24 months (range, 5 to 96 months). The clinical outcome was "cure" in 60.4% of patients, "improvement" in 32.1% of patients, and "no change" in the remaining patients. Bronchiectasis was documented prior to FOB by HRCT scan in 15 patients (27.3%). The duration of the deterioration of symptoms prior to presentation positively correlated with the development of bronchiectasis (p = 0.03) and an unfavorable clinical outcome (ie, improvement or no change) [p = 0.02]; a positive correlation was also found between the duration of symptoms and the development of bronchiectasis (p = 0.04). CONCLUSIONS: Timely medical intervention in patients with MLS that includes FOB with BAL prevents bronchiectasis that may be responsible for an ultimately unfavorable outcome.


Assuntos
Síndrome do Lobo Médio/terapia , Bronquiectasia/complicações , Líquido da Lavagem Broncoalveolar/citologia , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Síndrome do Lobo Médio/complicações , Síndrome do Lobo Médio/diagnóstico por imagem , Radiografia Torácica , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Nihon Kokyuki Gakkai Zasshi ; 39(1): 2-6, 2001 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-11296381

RESUMO

The clinical characteristics and chest CT scan findings in 77 cases of middle lobe and lingular syndrome, many of which were complicated with nontuberculous mycobacteriosis (21 cases, 27.3%), chronic sinusitis (16, 20.8%), or bronchopulmonary tuberculosis (11, 14.3%) are reported. Sixteen (76.2%) cases complicated with nontuberculous mycobacteriosis and 14 (87.5%) cases complicated with chronic sinusitis had granular shadows with dilated bronchi of both middle lobe and lingular in their chest CT scans. Granular shadows with a thickening of the bronchial wall or dilated bronchi were common characteristics of the chest CT scans of the patients with nontuberculous mycobacteriosis. However, cicatrization atelectasis of either middle lobe or lingular was the most common finding in patients with bronchopulmonary tuberculosis.


Assuntos
Síndrome do Lobo Médio/complicações , Infecções por Mycobacterium/complicações , Pneumonia Bacteriana/complicações , Sinusite/complicações , Tuberculose Pulmonar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/diagnóstico por imagem , Infecções por Mycobacterium/diagnóstico por imagem , Infecções por Mycobacterium/epidemiologia , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/epidemiologia , Sinusite/diagnóstico por imagem , Sinusite/epidemiologia , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia
13.
Chest ; 108(1): 150-2, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-7606950

RESUMO

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).


Assuntos
Síndrome do Lobo Médio/fisiopatologia , Testes de Provocação Brônquica , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Síndrome do Lobo Médio/complicações , Testes de Função Respiratória
20.
Acta Pathol Jpn ; 25(5): 539-53, 1975 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-173136

RESUMO

Eight foci of tumourlets of the lung and one allied lesion obtained from autopsy cases were histologically examined. The tumourlet of the lung consisted of epithelial cells and was considered to be a benign lesion. Small sized-lesion, uniformity of proliferating cells with very few mitosis and existence of associated lung lesions were documented as characteristic findings. However, the histopathogenesis of the tumourlet was not fully clarified. It was found that proliferating cells of tumourlets often show argyrophilia and contain numerous neurosecretory-like granules in their cytoplasm. These characteristics are very similar to Kultschitzky-like cells of the lung.


Assuntos
Carcinoma Adenoide Cístico/patologia , Carcinoma de Células Pequenas/patologia , Neoplasias Pulmonares/patologia , Adulto , Fatores Etários , Idoso , Broncopneumonia/complicações , Broncopneumonia/patologia , Feminino , Histocitoquímica , Humanos , Pulmão/ultraestrutura , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/complicações , Síndrome do Lobo Médio/patologia , Fatores Sexuais
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