Síndrome del lóbulo medio: presentación de un caso / Middle lobe syndrome: a case report

Fundamento: el síndrome de lóbulo medio en la actualidad se considera un síndrome clínico radiológico de curso crónico caracterizado por atelectasia o diversos grados de neumonitis, bronquiectasia recurrente o crónica, secundario a obstrucción o compresión por ganglios linfáticos del bronquio del lóbulo medio de origen infeccioso o neoplásico.Objetivo: describir un caso clínico de un paciente con el diagnóstico de síndrome del lóbulo medio causado por un linfoma no Hodgkin endobronquial.Caso clínico: paciente masculino de 19 años de edad, con antecedentes patológicos de asma bronquial. El motivo de ingreso fue malestar general, dolor en punta de costado derecha, disnea a los pequeños esfuerzos, fiebre de 38 grados centígrados con expectoración hemoptoica. Al examen físico se constató palidez cutánea mucosa, disminución del murmullo vesicular, presencia de estertores roncos y sibilantes en el campo pulmonar derecho. El diagnóstico se realizó por los estudios imaginológicos, y broncoscopia con la biopsia de la tumoración endobronquial.Conclusiones: el síndrome del lóbulo medio causado por un linfoma no Hodgkin endobronquial es un diagnóstico poco frecuente por lo cual se decidió presentar el caso(AU)

Background: middle lobe syndrome is currently considered a radiologic clinical syndrome characterized by atelectasis chronic course or varying degrees of pneumonitis and bronchiectasis, recurrent or chronic, secondary to obstruction or compression by lymph nodes of the infectious or neoplastic origin middle lobe bronchus.Objective: to describe a clinical case of a patient with the diagnosis of syndrome of the middle lobe caused by endobronchial non-Hodgkin's lymphoma.Clinical case: a 19-year-old male patient with a pathological history of bronchial asthma. The reason for entry was general discomfort, pain in right side end, dyspnea to small efforts, fever of 38 degrees Celsius, hemoptoic sputum. Physical examination found mucous skin pallor, decrease of the vesicular murmur, presence of grunting and hissing crackles in right lung field. The diagnosis was made by the imaging studio, and bronchoscopy with endobronchial tumor biopsy.Conclusions: the average caused by Lymphoma endobronchial lobe syndrome is a rare diagnosis; therefore it was decided to present this case(AU)

Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome.

OBJECTIVES: Middle lobe syndrome is a well-known clinical condition. In this retrospective study, we report our experience with a similar clinicopathological condition affecting the left lower lobe. METHODS: The data of 17 patients with atelectasis or bronchiectasis of the left lower lobe who underwent lobectomy during the period from January 2000 to December 2011 were reviewed. Demographic, clinical, radiological and surgical data were collected. RESULTS: Seventeen patients were included in this study, only one adult male patient of 52 years and 16 children. The paediatric patients were 10 boys and 6 girls, their age ranged from 2 to 11 years, mean 6.19 ± 2.6 years. Most patients presented with recurrent respiratory infection 15/17 (88.2%). The lag time before referral to surgery ranged from 3 to 48 months, mean 17.59 ± 13.1 months. Radiological signs of bronchiectasis were found in 11 (64.7%) patients. Bronchoscopy showed patent lower lobe bronchus in all patients. The criteria for lobectomy were evidence of bronchiectasis [11 (64.71%) patients], persistent atelectasis of the lobe after bronchoscopy and intensive medical therapy for a maximum of 2 months [6 (35.29%) patients]. Histopathological examination showed bronchiectasis in 11 (64.71%) patients, fibrosing pneumonitis in 4 (23.53%) patients and peribronchial inflammation in 2 (11.76%) patients. Most patients were doing well 1 year after surgery. CONCLUSIONS: Chronic atelectasis of the left lower lobe is a clinicopathological condition equivalent to middle lobe syndrome. Impaired collateral ventilation together with airway plugging with secretion is an accepted explanation. Surgical resection is indicated for bronchiectatic lobe or failure of 2-month intensive medical therapy to resolve lobar atelectasis.

Middle lobe syndrome.

Middle lobe syndrome is defined as recurrent or chronic collapse of the middle lobe of the right lung. It occurs in all age groups and is divided into an obstructive type, with a demonstrable airway occlusion, and a nonobstructive type, with a patent right middle lobe bronchus apparent on bronchoscopy. Middle lobe collapse has specific radiographic findings. Malignancy is the most common cause of the obstructive type, and infections are the second leading etiology. The nonobstructive type is associated with inflammatory conditions and bronchiectasis. In all cases, treatment is directed at the underlying cause.