• Journal of Chest Surgery
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• v.29 no.6
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• pp.621-625
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• 1996

"Middle lobe syndrome" which was described y Graham and associates at first is always caused by ex- ternal bronchial compression by Iymph nodes. Although the patients may not present any symptom, the most common presenting symptoms were cough, dyspnea, fever, hemoptysis, and chest pain. Diagnostic procedures includ chest X-ray bronchoscopy, brochography, chest CT, and the principal finding is the contracted middle lobe which is usually airless. We experienced fifteen cases of middle lobe syndrome from April 1990 to May 1995. Eleven patients were treated surgically. The surgical candidates for middle lobe syndrome are suspicious malignancy, fixed bronchiectasis, bronchostenosis, intractable to medical treatment, recurrent infection. Operations were right middle lobectomy (8), right middle and lower bilobectomy (2), right upper and middle bilobectomy (1). Postoperative histological findings were tuberculosis in six, chronic inflammation in three, malignancy in one, and focal hemorrhage in one. There were two cases of postoperat ve complications which were postoperative atelectasis and hepatopathy.patopathy.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.498-501
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• 2006

Occult bronchial foreign body is that long-standing foreign body lodge in bronchial tree. A 63-year-old male was admitted our hospital complaining of a cough. Chest computerized tomography and bronchoscopy showed collapse of right middle lobe and foreign body in the bronchus intermedius. After open thoracotomy and bronchotomy, foreign body was removed and collapsed middle lobe was ventilated. Herein we report a case of middle lobe syndrome caused by occult foreign body in the bronchus intermedius.

• Journal of Chest Surgery
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• v.6 no.1
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• pp.37-40
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• 1973

A rare case of broncholithiasis was reported, and briefly reviewed. A 44 year-old woman, showing the symptoms of hemoptysis. frequent attacks of fever,coughing and roentgenologically typical middle lobe syndrome, was surgically treated with resection. The removed lung showed typical middle lobe syndrome by broncholithiasis.

• Tuberculosis and Respiratory Diseases
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• v.39 no.3
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• pp.236-241
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• 1992

Background: As well as fiberoptic bronchoscopy, chest computerized tomographic scan can now differentiate the benign from malignant causes and the obstructive from non-obstructive causes of lung collapse. This study was designed to evaluate the usefulness of chest CT scan and fiberoptic bronchoscopy in the diagnosis of middle lobe syndrome. Method: We reviewed the clinical features, roentgenographic changes, pathologic findings and bronchoscopic findings in 16 patients with middle lobe syndrome who were admitted to Severance Hospital during period of January, 1987 through January, 1992. Results: The male to female ratio was 1:1. The most common symptoms were cough and sputums. Crackle was the most common physical finding. Underlying disease was lung cancer, pulmonary tuberculosis and endobronchial tuberculosis in 3 each other, benign stenosis in 2, lung abscess, broncholithiasis, bronchial chondroma, pneumonia and nonspecific inflammation in 1 each other. Conclusion: We conclude that the combination of chest computerized tomogram and fiberoptic bronchoscopy was most desirable for the diagnosis of middle lobe syndrome.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.133-139
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• 1984

Ten cases of the right middle lobe syndromes were experienced. Nine out of ten were treated surgically, six-right middle lobectomy, one-right middle and lower lobectomy, one-right middle lobectomy and decortication, one-incidental right pneumonectomy. Pathologic diagnosis were tuberculosis in five, bronchiectasis in two, organizing pneumonia in one, and foreign body granuloma in one. There were three postoperative complications, postoperative empyema-1, pleural effusion-1, pneu-monia-1. The surgical candidates for middle lobe syndromes were; 1.Suspicious malignancy 2.Fixed bronchiectasis 3.Bronchostenosis 4.Intractability to medical treatment or recurrent atelectasis and obstructive pneumonia.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.191-196
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• 1997

Although lipomas are common benign tumors in humans, endobronchial lipomas are quitely rare. Up to date, about 60 cases have been reported in the English literature. But endobronchial lipomas causing middle lobe syndrome were only 4 cases. These benign slow-growing tumors generally occur in the proximal portion of the lobar or segmental bronchi and originate from fatty tissue that is normally present in the bronchial tree. Smoking or chronic inflammation may be important in the pathogenesis of these tumors. Bronchoscopy is the definite diagnostic tool but, in general, open thoracotomy is required for diagnosis and treatment. Here, we present a case of endobronchial lipoma, with a review of the literature.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.549-556
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• 1999

Benign pulmonary tumors are rare entities, and among them bronchial lipomas are the most uncommon. Up to date, about 80 cases have been reported in the English literature. But, the bronchial lipoma with extrabronchial growth causing middle lobe syndrome and pneumonia is extremely rare. Bronchial lipomas, mainly arising from normal fatty tissue of the proximal portion of the lobar or segmental bronchi, are histologically benign. But if diagnosis and treatments are delayed, they can produce extensive pulmonary parenchymal damage and irreversible brochiectasis distally. So whenever possible, the treatment of choice is resection by means of bronchoscopy via early diagnosis. But if endoscopic removal is not possible because the distal end of the tumor could not be visualized by fiberoptic bronchoscopy or if the nature of the tumor is unclear, surgery is necessary, with lobectomy or pneumonectomy being required in most cases due to the extensively damaged pulmonary parenchyma. We present a case of bronchial lipoma with extrabronchial growth, with a review of the literature and report of an unusual case.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.136-141
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• 1999

Broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen and broncholithiasis is a relatively rare condition which related to late tissue response to healing granulomatous pulmonary infections, most commonly histoplasmosis or tuberculosis. The prominent symptoms of broncholithiasis are coughing followed by hemoptysis and symptoms related to bronchial obstruction. The complications include bronchoesophageal fistula and aortotracheal fistula. We report one case of broncholithiasis caused by Aspergillus. The case was a 53 year-old house wife whose chief complaints were recurrent fever, chill and malaise. The chest film revealed an avoid hazziness on the right middle lobe and chest cr scan showed consolidation of lateral segment of right middle lobe with calcified small low attenuated lesion in right middle lobe bronchus. Aspergillosis confirmed by pathology after bronchoscopic removal of impacted Aspergillus containing muddy plug from lateral segmental branch of right middle lobe bronchus.