The Role of Timely Intervention in Middle Lobe Syndrome in Children

• Published in: Chest Vol. 128; no. 4; pp. 2504 - 2510
• Main Authors: Priftis, Kostas N., Mermiri, Despina, Papadopoulou, Athina, Anthracopoulos, Michael B., Vaos, George, Nicolaidou, Polyxeni
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.10.2005; American College of Chest Physicians
• Subjects: Antibiotics; Asthma; BAL, bronchiectasis; Biological and medical sciences; Bronchiectasis - complications; Bronchoalveolar Lavage Fluid - cytology; Bronchoscopy; Cardiology. Vascular system; Child; Clinical outcomes; Cohort Studies; Cystic fibrosis; Female; fiberoptic bronchoscopy; Foreign bodies; Humans; Male; Medical sciences; middle lobe syndrome; Middle Lobe Syndrome - complications; Middle Lobe Syndrome - diagnostic imaging; Middle Lobe Syndrome - therapy; outcome; Patients; Physical therapy; Pneumology; Radiography, Thoracic; Recurrence; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Tomography, X-Ray Computed; RML; CF; MLS; FOB; fiberoptic bronchoscopy; HRCT; BAL, bronchiectasis; middle lobe syndrome; outcome; Human; Bronchoscopy; Respiratory disease; bronchiectasis; fiberoptic bronchoscopy; middle lobe syndrome; ontcome; Bronchus disease; Cardiovascular disease; Bronchiectasis; Endoscopy; Child; BAL; Syndrome
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.128.4.2504

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. 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. 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. 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). Timely medical intervention in patients with MLS that includes FOB with BAL prevents bronchiectasis that may be responsible for an ultimately unfavorable outcome.