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.
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.
Authors: D Gidaris; F Kanakoudi-Tsakalidou; D Papakosta; V Tzimouli; A Taparkou; M Ventouri; I Tsanakas Journal: Hippokratia Date: 2010-04 Impact factor: 0.471
Authors: F Fraioli; G Serra; G Ciarlo; V Massaccesi; S Liberali; A Fiorelli; F Macrì; C Catalano Journal: Radiol Med Date: 2012-10-22 Impact factor: 3.469
Authors: Hamdan Al-Jahdali; Abdullah Alshimemeri; Abdullah Mobeireek; Amr S Albanna; Nehad N Al Shirawi; Siraj Wali; Khaled Alkattan; Abdulrahman A Alrajhi; Khalid Mobaireek; Hassan S Alorainy; Mohamed S Al-Hajjaj; Anne B Chang; Stefano Aliberti Journal: Ann Thorac Med Date: 2017 Jul-Sep Impact factor: 2.219
Authors: Panayiotis Kouis; Myrofora Goutaki; Florian S Halbeisen; Ifigeneia Gioti; Nicos Middleton; Israel Amirav; Angelo Barbato; Laura Behan; Mieke Boon; Nagehan Emiralioglu; Eric G Haarman; Bulent Karadag; Cordula Koerner-Rettberg; Romain Lazor; Michael R Loebinger; Bernard Maitre; Henryk Mazurek; Lucy Morgan; Kim Gjerum Nielsen; Heymut Omran; Ugur Özçelik; Mareike Price; Andrzej Pogorzelski; Deborah Snijders; Guillaume Thouvenin; Claudius Werner; Zorica Zivkovic; Claudia E Kuehni; Panayiotis K Yiallouros Journal: Respir Res Date: 2019-09-18