• 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.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.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.

• 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 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.57 no.5
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• pp.477-483
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• 2024

Background: Torsion of the right middle lobe following right upper lobectomy is a rare but potentially fatal complication. To prevent this, fixation of the right middle lobe has been suggested. This study was performed to examine the impact of right middle lobe fixation on postoperative outcomes and bronchial changes. Methods: We enrolled patients who underwent curative-intent video-assisted thoracic surgery (VATS) right upper lobectomy for lung cancer from 2019 to 2022. Participants were grouped based on whether they did or did not receive right middle lobe fixation. Bronchial angles were measured using preoperative and postoperative chest computed tomography images, and postoperative outcomes and bronchial changes were compared between the 2 groups. Results: The study included a total of 50 patients, with 17 (34%) undergoing right middle lobe fixation. All procedures were performed using VATS. No significant differences between groups were observed in preoperative characteristics or postoperative outcomes. After surgery, both groups exhibited a significant increase in the right bronchus intermedius angle and a significant decrease in the branch angle. The postoperative right bronchus intermedius angle was significantly larger in the group without right middle lobe fixation compared to the group with fixation (47.38°±10.98° vs. 39.41°±9.21°, p=0.014). Three cases of atelectasis occurred in the group that did not undergo fixation while no cases were observed in the fixation group; however, this difference was not statistically significant. Conclusion: Fixation of the right middle lobe reduced postoperative angulation of the right bronchus intermedius, which may help prevent postoperative atelectasis.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.192-196
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• 2007

Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: $67.2{\pm}10.3years$), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common.

• The Korean Journal of Nuclear Medicine
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• v.28 no.3
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• pp.397-401
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• 1994

A twenty-one-year-old man visited our hospital due to abdominal distension for a month. On the physical examination, there was severe abdominal distension with fluctuation and shifting dullness. The routine laboratory results were within normal range. On the Magnetic Resonace angiography, there wasn't any blood flow within the right and middle hepatic vein. So we concluded that the etiologic disease was Budd-Chiari syndrome. On the liver scan, there was cold area(absence of radiouptake) on entire right lobe of the liver, increased uptake on the bone marrow and showed splenomegaly. This finding was similar to the liver mass occupying right lobe with underlying chronic liver disease. On the previous reports, it is quite uncommon finding that Budd-Chirari syndrome shows lesion like space occupying one on the liver scan. So we report this case with a review of the literature.

• Clinical and Experimental Pediatrics
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• v.48 no.4
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• pp.438-442
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• 2005

Kawasaki disease is an acute febrile vasculitis that occurs predominantly in young children under 5-years-old. The patients present generally with a high spiking fever that is unresponsive to antibiotics and lasts for more than five days at least. Prolonged fever has been shown to be a risk factor in the development of coronary artery disease. It seems to be certain that infectious agents are associated with the pathogenesis of Kawasaki disease. The differential diagnosis of Kawasaki disease must rule out infectious diseases including scarlet fever, toxic shock syndrome, measles, and so on. This is very important for adequate treatment and prevention of cardiac complications of Kawasaki disease. We experienced a 25-month-old boy who had high fever and pneumonic consolidation in the right middle and lower lobe of the lung that was considered as mycoplasma pneumonia on admission and developed coronary artery aneurysmal dilatation during treatment with roxythromycin.