Middle lobe syndrome : clinicopathological characteristics

Abstract

Twenty-nine patients with non-malignant neoplastic middle lobe syndrome were reviewed. There were 11 males and 18 females ranging from 23 to 85 years (mean, 59.6 years). The right middle lobe was involved in 27 patients and the lingula in 2 patients. Sixteen patients underwent surgical resection and 13 conservative therapies (resection ratio : 55 %). This disease was most common in patients aged between 50 and 60 years (66 %). All the patients between the ages of 40 and 50 underwent surgery, in contrast to none of the patients between 70 and 80. None of the patients without symptoms underwent surgery. The predominant bronchoscopic abnormalities, such as mucosal inflammation, edema, granulomatous change, and irregular narrowing, were found in 83 % of the patients. Seventeen percent of the patients had normal bronchoscopic findings. Each one case had the lesion originating from tuberculosis and extrinsic bronchial compression. The reasons why surgical procedures avoided included effective medical treatments (antibiotics for pneumonia in 10, bronchial artery embolization for hemoptysis in 2), high age and low pulmonary function in 5, and other similar lesion besides middle lobe in 2 patients. Surgical indication should be determined carefully according to the presenting symptoms and clinical course. Bronchial stenting and thoracoscopic approach should be considered.