ABSTRACT
INTRODUCTION: Middle lobe syndrome (MLS) is a relatively uncommon lung disease that is characterized by damage to the middle lobe and often needs surgical intervention. OBJECTIVE: To study clinical, radiological and histological features of all patients who underwent surgical resection for MLS in Iceland over a 13-year period, including evaluation of surgical outcome. METHODS: Information on patients who underwent surgery of the right middle lobe in Iceland from 1984 to 2006 was obtained from a centralized diagnosis and pathology registry. Clinical data were collected retrospectively from clinical records from hospitals and from private offices. All pathology specimens were reviewed. RESULTS: We studied 18 patients, 3 males and 15 females between the ages 2 and 86 years (mean 55). The most common clinical features were recurrent infection (n = 15), chronic cough with productive sputum (n = 9), chest pain (n = 8) or dyspnea (n = 7). The most common findings on chest radiographs and on computerized tomography of the chest were atelectasis, consolidation and bronchiectasis. One patient had a foreign body. The most common major histological finding was bronchiectasis in nine patients, and two had foreign body reaction. Minor findings included bronchiolitis, organizing pneumonia and peribronchial inflammation. All patients survived surgery with minor peri- and postoperative complications. CONCLUSION: MLS is more common in females, and recurrent infections, chronic productive cough and dyspnea were the most common symptoms. Bronchiectasis is the most common histological finding. MLS can be treated effectively with lobectomy with low mortality and rate of complications.
Subject(s)
Middle Lobe Syndrome/epidemiology , Middle Lobe Syndrome/surgery , Pneumonectomy/methods , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Bronchoscopy/methods , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Humans , Iceland/epidemiology , Incidence , Male , Middle Aged , Middle Lobe Syndrome/diagnostic imaging , Pneumonectomy/adverse effects , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Radiography, Thoracic , Respiratory Function Tests , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Survival Rate , Tomography, X-Ray Computed , Young AdultABSTRACT
OBJECTIVE: Closed pleural biopsy is done to determine causes of pleural effusion after fluid analysis has been nondiagnostic. The aim of the study was to evaluate results of closed pleural biopsy in Iceland. MATERIAL AND METHODS: All pathology reports of closed pleural biopsy from 1990-1999 at the Department of Pathology were reviewed. Hospital records for these patients were screened. RESULTS: There were 130 samples from 120 individuals. There were 74 males and 46 females. Deceased are 75/120. The most common diagnosis was pleuritis or fibrosis in 85/120, cancer in 15 and three had tuberculosis but 17/120 had other results. The sensitivity of a closed pleural biopsy for diagnosing cancer was 27%. Adding cytology increased the sensitivity to 56%. Of those that had pleuritis on initial biopsy the cause was found to be cancer in 33/85, pneumonia in 11, trauma in 5 and in 8 there were other causes. In 25/85 no etiology could be found. By doing further studies it was demonstrated that the cause for the fluid was malignancy in 55/120. Of those most had lung cancer or 24/55, and the second most common cause was breast cancer in 7. Despite further studies no cause was found in 32/85. CONCLUSIONS: Closed pleural biopsy has fairly low sensitivity for diagnosis of cancer but it can be increased by adding cytologic evaluation. It is necessary to do further investigations and follow-up in patients that have inflammation in pleural biopsy.
