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
