• 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.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.731-735
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• 1986

Atelectasis with chronic pneumonitis affecting the right middle lobe secondary to compression of the middle lobe bronchus by enlarged indurated or calcified peribronchial nodes is defined as middle lobe syndrome clinicopathologically. The lesion in this series of case reports including tuberculous lymphadenitis, lung cancer, atelectasis and lung abscess with organizing pneumonitis, had been treated by lobectomy. Postoperative courses were uneventful in all patients. Herewith, we report these four experiences with review of literature.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.118-121
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• 2003

A 25-year-old female patient was adimitted due to discomfort in the right chest and left epigastric area. Chest X-ray and chest CT showed a round 4$\times$4$\times$4cm sized mass located in the right lower lobe and abutted on the right diaphragm and metastatic lesions in the right lower lobe and right middle lobe. In exploratory thoracotomy, we discovered a mass originating from the right diaphragm which directly invaded the right lower lobe and metastatic subpleural lesions in the right lower lobe and right middle lobe. The mass was diagnosed as sarcoma by frozen section biopsy and we removed the mass by on bloc resection of the right diaphragm and right lower lobe. Metastatic subpleural lesions in the right lower lobe and right middle lobe were removed by wedge resection. The mass was malignant fibrous histiocytoma of the diaphragm in permanent pathologic examination and chemotherapy was done as adjuvant measure. We report one extremely rare case of malignant fibrous histiocytoma of the diaphragm with literature.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.532-536
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• 2008

We report on a case of a patient with laryngo-tracheobronchial amyloidosis who complained of cough, sputum, and hoarseness. A chest X-ray showed consolidation in the right middle lobe. A chest CT scan showed diffuse, irregular narrowing of the tracheobronchial tree and atelectasis of the right middle lobe, with calcification of bronchial wall. Bronchoscopic findings were multinodular submucosal thickening of the right vocal cord, and yellowish multinodular submucosal thickening from the lower trachea through both main bronchi, as well as the lingular division of the left upper lobe, the right middle lobe, and the right lower lobe. The right middle lobe bronchus was nearly obstructed. The diagnosis of amyloidosis was made by multiple ronchoscopic biopsies on the right vocal cord and both bronchi. Pathologic findings were characteristic apple-green birefringence under polarized microscopy with Congo-red stain. The patient had no evidence of systemic amyloidosis. The patient is under conservative symptomatic treatment.

• Journal of Veterinary Clinics
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• v.32 no.6
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• pp.530-535
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• 2015

An 11-year-old intact female miniature poodle presented with a four-month history of hemorrhagic effusion. The patient was alert on physical examination, although muffled heart sounds were noted upon auscultation of the right hemithorax. The radiographic finding was pleural effusion. Ultrasonography revealed cystic changes in both ovaries and several nodules in the liver. A refractory opacity in the right lung field, as visualized with computer tomography (CT), was diagnosed as right middle lung lobe torsion with a collapsed bronchus. Five days after diagnosis, a right fifth intercostal thoracotomy was performed to remove the right middle lung lobe; the right middle lung lobe was grossly shrunken as a result of chronic lung lobe torsion. Ovariohysterectomy was also performed. Histopathologic examination revealed papillary adenocarcinoma in both ovaries and suspected metastasized ovarian adenocarcinoma cells in the lung lobe. The patient recovered favorably and had been doing well up to two months post-surgery. However, after four months, the dog presented with respiratory difficulty. The radiographic findings were pleural effusion and collapse of the right cranial and left caudal lung lobes. Malignant cells of epithelial origin were observed in the pleural effusion. The tumor cells were suspected to be metastasized cells from the previously resected lung lobe. Although cancer treatment was recommended, the suggestion was suspended and the dog was discharged from hospital. This was a case of lung lobe torsion that had occurred because of hemorrhagic effusion due to tumor. Although ovariohysterectomy and lobectomy were performed, there was a relapse of hemorrhagic effusion because of metastasized tumor from the previously resected lung lobe.

• Journal of Chest Surgery
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• v.13 no.1
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• pp.66-71
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• 1980

This is one case report of coexisting two histologically different carcinomas in the different lobes of the right lung, which operated the right pneumonectomy in the Dept. of Thoracic and Cardiovascular Surgery Hanyang University Hospital. The 43 years old male patient complained coughing, blood tinged sputum and weight loss. The chest films [PA and lateral view] showed a small round hazy shadow in the posterior segment of the right upper lobe and irregular hazy densities in the right middle lobe and hilar area. Histopathologically, the tumor in the posterior segment of the right upper lobe was consisted of a tissue of adenocarcinoma and the tumor in the right middle lobe was consisted of a tissue of well-differentiated bronchial squamous cell carcinoma.

• 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.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1428-1431
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• 1992

In a 14-days-old boy chest roentgenogram examination because of dyspnea and cyanosis revealed hyperlucency of entire right lung field with herniation of mediastinum into the left hemithorax, Surgical exploration showed the right lower lobe to be site of congenital lobar emphysema, while the right upper and middle lobe were collapsed. Right lower lobectomy was successfully performed.

• Journal of Veterinary Clinics
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• v.28 no.2
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• pp.262-266
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• 2011

A 4-year-old intact male, Maltese dog weighing 2.2 kg was presented for evaluation of tachypnea and hyperthermia. On initial evaluation, the dog was dyspneic, but alert and responsive. Muffled heart sound was noted with auscultation of the right hemithorax. The radiographic findings were consolidation of the right middle lung lobe, pleural effusion, and abdominal fluid accumulation. Thoracic computed tomography confirmed a contrast-enhancing mass within the right middle lung lobe. Surgical exploration of the thoracic cavity was performed using a right fifth intercostal thoracotomy. Examination of the right lung lobe revealed $360^{\circ}C$ torsion of the right middle lung lobe at the level of the hilus, in a clockwise direction. Lung lobectomy was performed using a thoracoabdominal stapling device with 2.5-mm vascular staples. Full-thickness intestinal biopsy by exploratory laparotomy was taken from the jejunum for histological assessment. Histopathologic examination of the full-thickness intestinal biopsy revealed distended lacteal located within the submucosa of the jejunum. Intestinal lymphangiectasia was resolved with prednisone and low fat diets. Subsequent communication with the owner revealed that the patient was in good health 6 months post-discharge.

• 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.