RESUMO
Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion. Bronchoscopy continues to play a key role in its diagnosis. Though atelectasis is not uncommon in these patients, EBTB presenting as a middle lobe syndrome (MLS) has rarely been documented. MLS refers to chronic or recurrent collapse of the right middle lobe and has a myriad of causes. The pathogenesis of this entity too is not fully established. We report this exceptional clinical manifestation in a 19-year-old male, who presented for evaluation of respiratory symptoms for 6 months along with constitutional complaints. Imaging suggested the presence of MLS and bronchoscopy established the diagnosis of endobronchial tuberculosis. GeneXpert evaluation of bronchial aspirate detected Mycobacterium tuberculosis. Histopathology confirmed the presence of granulomatous lesions. Subsequently, the cultures of bronchial aspirate and post-bronchoscopy sputum grew M. tuberculosis. Appropriate therapy with anti-tuberculosis drugs resulted in a remarkable symptomatic and radiological improvement. EBTB presenting as a MLS is a distinct rarity.
Assuntos
Broncopatias/diagnóstico , Broncopatias/microbiologia , Síndrome do Lobo Médio , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Adulto , Biópsia , Broncoscopia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Masculino , Síndrome do Lobo Médio/diagnóstico , Síndrome do Lobo Médio/microbiologia , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
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Assuntos
Humanos , Masculino , Feminino , Síndrome do Lobo Médio/complicações , Síndrome do Lobo Médio/diagnóstico , Síndrome do Lobo Médio/microbiologia , Mycobacterium avium , Mycobacterium avium/isolamento & purificação , Complexo Mycobacterium avium , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/complicações , Síndrome do Lobo Médio/tratamento farmacológico , Síndrome do Lobo Médio/fisiopatologia , Mycobacterium avium/citologia , Mycobacterium avium/patogenicidade , Complexo Mycobacterium avium/patogenicidadeRESUMO
From 1988 to 1995, a bronchial washing was performed on 118 cases of middle lobe syndrome at the National Himeji Hospital. Twenty cases (16.9%) were positive for Mycobacterium avium complex (MAC). All cases were middle-aged (mean age 54.8), non-smoking women. Fourteen cases were asymptomatic and showed only abnormal shadow on chest X-ray film, while others complained cough, sputum or hemosputum. CT examinations were done on 13 patients, and pulmonary infiltrations were found in addition to right middle lobe or lingula in many cases. It is important to note that MAC infection might be one of causes of middle lobe syndrome.
Assuntos
Síndrome do Lobo Médio/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , Adulto , Idoso , Lavagem Broncoalveolar , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a middle lobe syndrome. Evaluation of the patient led to the diagnosis of concomitant allergic bronchopulmonary aspergillosis with allergic Aspergillus sinusitis, a rarely reported association.
Assuntos
Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose/complicações , Aspergillus fumigatus , Síndrome do Lobo Médio/complicações , Sinusite/complicações , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Lobo Médio/diagnóstico , Síndrome do Lobo Médio/tratamento farmacológico , Síndrome do Lobo Médio/microbiologia , Prednisolona/uso terapêutico , Sinusite/tratamento farmacológico , Sinusite/microbiologiaRESUMO
Twenty one children with asthma aged 1.0-10.5 years (mean (SD) 3.3 (2.5) years) were admitted to the hospital to evaluate pulmonary right middle lobe or lingular collapse lasting one to 12 months (mean (SD) 4.4 (3.8) months). Seven children had mild asthma and were treated with inhaled beta 2 agonists as needed. Nine had moderate asthma treated with either sodium cromoglycate or slow release theophylline. Five had severe asthma treated with inhaled steroids. Each child underwent fibreoptic bronchoscopy under local anaesthesia and a bronchoalveolar lavage. Differential cell counts of the lavage fluid revealed predominance of neutrophils in 12 patients (57%). In nine of these patients cultures grew pathogenic bacteria, mainly Haemophilus influenzae and Streptococcus pneumoniae. There was no correlation between the severity of asthma and a positive bacterial culture. There was also no correlation between the duration of the right middle lobe collapse and a positive culture. We conclude that longstanding right middle lobe collapse in asthmatic children is often associated with bacterial infection.