RESUMO
BACKGROUND: Right middle lobe syndrome is part of a spectrum of relatively rare but serious conditions that may occur following right upper lobectomy. We aimed to assess whether the preoperative middle lobe bronchial angle on CT predicted patients at risk of developing middle lobe syndrome. METHOD: All patients who had a complete upper lobectomy over 4 years were retrospectively reviewed for clinical and imaging findings of middle lobe syndrome. Patients with previous lung surgery, preoperative chemo- or radiation therapy, or more extensive surgical resection were excluded. Patient demographics and symptoms, the surgical, pathologic and bronchoscopy reports, and pre- and post-operative chest imaging, to include 3D CT reconstructions and measurements of the middle lobe angles in a subset of patients, were retrospectively reviewed. RESULT: One hundred and twenty-eight patients met inclusion criteria. Ten (8%) had middle lobe syndrome based on symptoms and imaging features. Eight had severe middle lobe consolidation. Two had postoperative onset of wheezing, with middle lobe bronchial abnormality on CT. The pre- and postoperative middle lobe bronchial angles of 14 patients without middle lobe syndrome were compared to 10 patients with middle lobe syndrome. The middle lobe bronchus was completely obliterated postoperatively and could not be determined in 1 patient. There was no significant difference between the pre- and postoperative angles in patients with or without middle lobe syndrome. CONCLUSION: Middle lobe syndrome occurred in 8% of patients with right upper lobectomy. The preoperative middle lobe bronchial angle did not predict patients at risk for developing middle lobe syndrome.
Assuntos
Neoplasias Pulmonares , Síndrome do Lobo Médio , Humanos , Síndrome do Lobo Médio/diagnóstico por imagem , Síndrome do Lobo Médio/etiologia , Síndrome do Lobo Médio/patologia , Neoplasias Pulmonares/patologia , Estudos Retrospectivos , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pulmão/cirurgia , Brônquios/diagnóstico por imagem , Brônquios/cirurgiaRESUMO
Tuberculosis associated Immune reconstitution inflammatory syndrome (IRIS) in a HIV negative patient can present with a multitude of clinic-radiological presentations that are often confused with drug resistance/treatment failure. Being a diagnosis of exclusion, this clinical entity is often prone to under-diagnosis. We present a series of 5 patients who presented with varied but uncommon IRIS manifestations. High index of suspicion coupled with clinical reasoning and judicious use of phenotypic and genotypic culture methods helped in their timely detection and successful treatment.
Assuntos
Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Síndrome do Lobo Médio/diagnóstico por imagem , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Antituberculosos/uso terapêutico , Tosse/fisiopatologia , Farmacorresistência Bacteriana/genética , Dispneia/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/tratamento farmacológico , Mycobacterium tuberculosis/genética , Técnicas de Amplificação de Ácido Nucleico , Paresia/fisiopatologia , Derrame Pleural/fisiopatologia , Prednisona/uso terapêutico , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/fisiopatologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto JovemRESUMO
Prostate cancer cells have abundant expression of the cell surface protein prostate-specific membrane antigen (PSMA). In recent years, PET radioligands detecting this protein has therefore gained substantial interest in prostate cancer staging. It turned out that PSMA expression can be evident in both malignant and benign lesions, and we have previously reported that pulmonary opacities and bronchiectasis can be avid on Ga-PSMA PET/CT. Here, we present a case with Ga-PSMA accumulation in nonobstructive middle lobe syndrome, which further indicate that benign changes in the lungs may be falsely interpreted as malignant disease.
Assuntos
Ácido Edético/análogos & derivados , Síndrome do Lobo Médio/metabolismo , Oligopeptídeos/metabolismo , Idoso , Transporte Biológico , Ácido Edético/metabolismo , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Masculino , Síndrome do Lobo Médio/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaAssuntos
Neoplasias Pulmonares/cirurgia , Síndrome do Lobo Médio/diagnóstico por imagem , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Meios de Contraste , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/etiologia , Síndrome do Lobo Médio/cirurgia , Pneumonectomia/métodos , Reoperação/métodos , Tomografia Computadorizada por Raios X/métodos , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Resultado do TratamentoRESUMO
Lepidic adenocarcinoma previously known as bronchioloalveolar carcinoma (BAC) is a non-small cell lung cancer with an indolent presentation. Bronchial anthracofibrosis (BAF) is caused by long-standing exposure to biomass fuel smoke often in poorly ventilated kitchen. Middle lobe syndrome (MLS) due to BAF is not uncommon however, lepidic adenocarcinoma then known as BAC, presenting as MLS has been documented only once before in the Polish literature. A 68-year-old never-smoker female with biomass fuel smoke exposure presented with cough and breathlessness. Imaging revealed MLS. Fiberoptic bronchoscopy visualised bluish-black hyperpigmentation with narrowing and distortion of right middle lobe bronchus suggestive of BAF. Transbronchial biopsy confirmed presence of lepidic adenocarcinoma. To our knowledge, this is the first detailed description of lepidic adenocarcinoma and BAF presenting as MLS.
Assuntos
Adenocarcinoma Bronquioloalveolar/patologia , Antracose/patologia , Síndrome do Lobo Médio/patologia , Fumaça/efeitos adversos , Adenocarcinoma Bronquioloalveolar/complicações , Idoso , Antracose/complicações , Biomassa , Broncopatias/patologia , Broncoscopia/métodos , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Humanos , Perda de Seguimento , Síndrome do Lobo Médio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosAssuntos
Síndrome do Lobo Médio/etiologia , Silicose/complicações , Tuberculose/complicações , Idoso , Brônquios/diagnóstico por imagem , Humanos , Pulmão , Masculino , Síndrome do Lobo Médio/diagnóstico por imagem , Silicose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico por imagemRESUMO
Imaging is crucial to the diagnosis of pulmonary hydatid disease, as it is often the first modality that raises suspicion of the disease. Middle lobe syndrome (MLS) as a presentation of this disease is a distinct rarity. A 45-year-old woman, a never-smoker, presented with cough and streaky haemoptysis. Imaging demonstrated a trapezoidal opacity with its base towards the hilum and contiguous with the right cardiac border. The reformatted sagittal view confirmed the diagnosis of MLS. Fibreoptic bronchoscopy (FOB) revealed an avascular white membranous structure wholly occluding the medial segment of the middle lobe. This was completely removed through gentle suction. Bronchial aspirate revealed hooklets of hydatid and echinococcal serology was positive. Subsequently, three cycles of albendazole were administered with remarkable clinical and radiological improvement. To the best of our knowledge, this is the first detailed description of MLS caused by pulmonary hydatidosis that was completely removed through FOB.
Assuntos
Equinococose Pulmonar/complicações , Síndrome do Lobo Médio/diagnóstico por imagem , Albendazol/uso terapêutico , Broncoscopia/métodos , Equinococose Pulmonar/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome do Lobo Médio/parasitologia , Síndrome do Lobo Médio/cirurgia , Resultado do TratamentoAssuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Síndrome do Lobo Médio/diagnóstico por imagem , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/fisiopatologia , Obstrução das Vias Respiratórias/terapia , Brônquios/fisiopatologia , Broncografia , Criança , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Pessoa de Meia-Idade , Síndrome do Lobo Médio/etiologia , Síndrome do Lobo Médio/fisiopatologia , Síndrome do Lobo Médio/terapia , Tomografia Computadorizada MultidetectoresAssuntos
Pneumopatias/etiologia , Derrame Pleural/complicações , Anormalidade Torcional/etiologia , Comorbidade , Humanos , Cirrose Hepática/epidemiologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/complicações , Síndrome do Lobo Médio/diagnóstico por imagem , Síndrome do Lobo Médio/epidemiologia , Síndrome do Lobo Médio/cirurgia , Pneumonectomia , Recidiva , Tomografia Computadorizada por Raios X , Anormalidade Torcional/epidemiologia , Anormalidade Torcional/cirurgiaRESUMO
PURPOSE: The authors evaluated the role of magnetic resonance (MR) imaging of the chest in comparison with chest X-ray in the follow-up of pulmonary abnormalities detected by computed tomography (CT) in paediatric patients with middle lobe syndrome. MATERIALS AND METHODS: Seventeen patients with middle lobe syndrome (mean age 6.2 years) underwent chest CT at the time of diagnosis (100 kV, CARE dose with quality reference of 70 mAs; collimation 24×1.2 mm; rotation time 0.33 s; scan time 5 s); at follow-up after a mean of 15.3 months, all patients were evaluated with chest MR imaging with a respiratory-triggered T2-weighted BLADE sequence (TR 2,000; TE 27 ms; FOV 400 mm; flip angle 150°; slice thickness 5 mm) and chest X-ray. Images from each modality were assessed for the presence of pulmonary consolidations, bronchiectases, bronchial wall thickening and mucous plugging. Hilar and mediastinal lymphadenopathies were assessed on CT and MR images. RESULTS: Baseline CT detected consolidations in 100% of patients, bronchiectases in 35%, bronchial wall thickening in 53% and mucous plugging in 35%. MR imaging and chest X-ray identified consolidations in 65% and 35%, bronchiectases in 35% and 29%, bronchial wall thickening in 59% and 6% and mucous plugging in 25% and 0%, respectively. Lymphadenopathy was seen in 64% of patients at CT and in 47% at MR imaging. CONCLUSIONS: Patients with middle lobe syndrome show a wide range of parenchymal and bronchial abnormalities at diagnosis. Compared with MR imaging, chest X-ray seems to underestimate these changes. Chest MR imaging might represent a feasible and radiation-free option for an overall assessment of the lung in the follow-up of patients with middle lobe syndrome.
Assuntos
Imageamento por Ressonância Magnética/métodos , Síndrome do Lobo Médio/patologia , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X , Criança , Feminino , Seguimentos , Humanos , Masculino , Síndrome do Lobo Médio/diagnóstico por imagemAssuntos
Broncopneumonia/diagnóstico por imagem , Tosse/etiologia , Pulmão/diagnóstico por imagem , Síndrome do Lobo Médio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/cirurgia , Broncopneumonia/cirurgia , Doença Crônica , Tosse/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome do Lobo Médio/cirurgia , PneumonectomiaRESUMO
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.
Assuntos
Síndrome do Lobo Médio/epidemiologia , Síndrome do Lobo Médio/cirurgia , Pneumonectomia/métodos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Broncoscopia/métodos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Islândia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/diagnóstico por imagem , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Radiografia Torácica , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
PURPOSE: Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS. PATIENTS AND METHODS: We retrospectively reviewed the records of 22 patients with EBTB presenting as RMLS who were diagnosed at our hospital from 2003 to 2006. RESULTS: Its occurrence was more common in females than males (F, 18; M, 4). The mean age was 70.3 +/- 8.5 years, and 17 patients were above the age of 65 years. Cough with sputum was the most common manifestation and 2 patients were asymptomatic. In bronchoscopic analysis, the most common finding was edematous-type EBTB, which was found in 15 patients, followed by actively caseating type in 6 and tumorous type in 1. Acid-fast bacilli (AFB) staining for bronchial washing fluid was positive in only 5 patients: 1 with edematous type and 4 with actively caseating type. Bronchoscopic biopsy showed chronic granulomatous inflammation in 16 patients. Follow-up chest X-ray after treatment showed complete disappearance of the lesion in 2 patients, more than 50% improvement in 5, less than 50% improvement in 5, and no change of lesion in 4. CONCLUSION: Edematous-type EBTB was the most common type of EBTB presenting as RMLS, and it usually occurred in elderly patients. Culturing for mycobacterium and histologic examination by bronchoscopy are necessary for proper diagnosis in these patients.
Assuntos
Broncopatias/diagnóstico por imagem , Broncopatias/patologia , Síndrome do Lobo Médio/diagnóstico por imagem , Síndrome do Lobo Médio/patologia , Tuberculose/diagnóstico por imagem , Tuberculose/patologia , Idoso , Idoso de 80 Anos ou mais , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Tuberculose/complicaçõesRESUMO
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 XAssuntos
Erros de Diagnóstico , Pneumopatias/diagnóstico , Adolescente , Biópsia , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Malformação Adenomatoide Cística Congênita do Pulmão/terapia , Diagnóstico Diferencial , Erros de Diagnóstico/efeitos adversos , Erros de Diagnóstico/prevenção & controle , Humanos , Lactente , Pneumopatias/diagnóstico por imagem , Pneumopatias/terapia , Masculino , Síndrome do Lobo Médio/diagnóstico , Síndrome do Lobo Médio/diagnóstico por imagem , Síndrome do Lobo Médio/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: Middle lobe syndrome (MLS) is one of the complications of asthma. Its signs and symptoms are often nonspecific, causing delay in appropriate treatment. We aimed to review our pediatric asthmatic patients and provide differential characteristics between MLS and asthma worsening in order to target early diagnosis. METHOD: File records of all asthmatics (n=3528) seen in our clinic during the last 2 years were retrospectively reviewed to identify the patients with MLS, and a case-control study was undertaken. Files of 56 asthmatic children diagnosed as MLS, with a total of 63 episodes, and 63 matched controls with asthma worsening were analyzed and compared. RESULTS: The incidence of MLS was 1.62% and half were below or at the age of 6. All cases with MLS were documented radiologically, and only 5 of the 63 episodes had physical findings suspicious for MLS. The most affected segments were right middle lobe (50%) and left lingula (26.2%). Although in all cases symptoms cleared, in 23 (36.5%) cases, atelectasis persisted radiologically. Compared to controls, patients with MLS included less atopics (34.9% vs. 59.4%, p<0.05) and fewer boys (52.4% vs. 71.4%, p<0.05), and they reported less frequent dyspnea (57.1% vs. 85.9%), more frequent sputum production (49.2% vs. 7.8%), and longer duration of complaints (22.0+/-6.23 vs. 2.4+/-0.31 days) (p<0.001, for each). Furthermore, the resolution of symptoms took significantly longer (45.2+/-9.3 vs. 3.3+/-0.4 days, p<0.001). CONCLUSION: We conclude that complicating MLS in childhood asthma is more frequent in younger ages, girls, and nonatopics. In most cases, physical findings are not informative, and chest radiographs diagnose most but not all cases. The most suggestive symptoms are unresolving/persisting symptoms during admission and/or following treatment.
Assuntos
Asma/complicações , Asma/diagnóstico , Síndrome do Lobo Médio/diagnóstico , Adolescente , Fatores Etários , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Masculino , Síndrome do Lobo Médio/diagnóstico por imagem , Síndrome do Lobo Médio/etiologia , Radiografia , Estudos Retrospectivos , Fatores SexuaisRESUMO
STUDY OBJECTIVE: To review our experience with specific characteristics, indications, and results of pulmonary resection in children with middle lobe/lingula syndrome. DESIGN: Retrospective cohort study. SETTING: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. PATIENTS AND INTERVENTION: Thirteen children with middle lobe, lingula, or both syndromes were treated with pulmonary resection from January 1995 to December 1999. RESULTS: The mean age was 7.5 years (range, 5 to 10 years). Eight patients were girls, and five were boys. All patients underwent high-resolution CT and bronchoscopy. Bronchiectasis and atelectasis of right middle lobe, lingula, or both was noted in nine patients. Bronchial stenosis and inflammation of the bronchus was found endoscopically in four patients. The indications for surgery were recurrent respiratory tract infection with persistent atelectasis and bronchiectasis in nine patients, and recurrent respiratory tract infection with bronchiectasis in four patients. A right middle lobectomy was done on seven patients and a lingulectomy on four patients. Two patients underwent staged thoracotomies (right middle lobectomy and lingulectomy). There were no operative deaths. Only two patients had postoperative complications: atelectasis (n = 1), and pneumothorax (n = 1). Mean follow-up was 3.5 years (range, 3 to 5 years) for all patients. Nine patients were asymptomatic, and four patients had improved. CONCLUSION: Right middle lobe or lingula syndrome with the presence of bronchiectasis, bronchial stenosis, or failure of lung to re-expand are indications for early pulmonary resection.
Assuntos
Síndrome do Lobo Médio/cirurgia , Pneumonectomia , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Síndrome do Lobo Médio/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Results of treatment of 242 patients with middle-lobe syndrome are analyzed. Indications for surgical treatment of middle-lobe syndrome must be determined very individually. Organo-saving surgeries are the methods of choice for benign processes in the middle lobe. In malignant tumors, destructive and cirrhotic processes of the middle lobe the resections are indicated.
Assuntos
Síndrome do Lobo Médio/cirurgia , Adolescente , Adulto , Bronquiectasia/complicações , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/diagnóstico por imagem , Síndrome do Lobo Médio/tratamento farmacológico , Síndrome do Lobo Médio/etiologia , Seleção de Pacientes , Pneumonectomia/métodos , Radiografia , Resultado do TratamentoRESUMO
Two different processes have been proposed for pathogenesis of Mycobacterium avium complex (MAC) disease which show the middle lobe syndrome: 1) middle lobe bronchiectasis followed by MAC infection and 2) MAC disease resulted in secondary bronchiectasis. Two surgical specimen from MAC cases showing middle lobe syndrome were studied histo-pathologically. The first case was a 60 year-old female with frequent bloody sputum, who had been diagnosed as bronchiectasis in her childhood. Pathological examination of the resected middle lobe showed prominent cylindric bronchiectasis in the indurated middle lobe, and epithelioid cell granulomas were scattered limited to the fibrous bronchial walls, without any granulomas in the lung parenchyma. These findings suggested a secondary infection of MAC to the non-specific pre-existed bronchiectasis. The second case of a 55 year-old female having repeated bloody sputum, who was diagnosed to be tuberculosis but no improvement with anti-tuberculosis drugs. Pathological examination of the middle lobe showed scattered epithelioid cell granulomas with lymphocytic infiltration in the lung parenchyma. A few epithelioid cell granulomas were also found in the mucosa of middle lobe bronchi. In this case, pulmonary MAC lesions seemed to precede the central bronchial lesion with later development of bronchiectasis. Summarizing above findings two different mode of pathogenesis ways may be considered; one is non-specific bronchiectasis followed by middle lobe MAC disease and the other is pulmonary MAC lesion in the middle lobe as a primary change.