![]() The hypothesis is that ineffective collateral ventilation may play a significant role in the pathophysiology of middle lobe syndrome. The collateral ventilation of the middle lobe constitutes a zone of high resistance in comparison to the upper lobes, as a result of the higher ratio of pleural to the non-pleural surface area. In the nonobstructive type, there is no identifiable obstruction on bronchoscopic evaluation, and the physiological basis of the recurrent atelectasis is poorly understood. ![]() Other more exotic etiologies that cause an intraluminal obstruction, described in previous literature as isolated case reports, include sarcoidosis, aspiration, mucus plugs, and broncholiths. The most common etiology of the obstructive type is often subject to mediation by peribronchial lymphadenopathy secondary to granulomatous diseases, endemic fungal infections, and various mycobacterial species. It can classify into two subtypes: intraluminal or extraluminal obstruction.Įxtrinsic compression may involve a plethora of tumors, including hamartomas, primary lung cancers, and distant metastasis from unknown primaries. The obstructive type of middle lobe syndrome usually results from extrinsic compression of the right middle lobe bronchus resulting from peribronchial lymphadenopathy or tumors that exploit the anatomic peculiarities of the right middle lobe bronchus. Though there has been no established definition of middle lobe syndrome, it has been recognized to involve two fundamentally different pathophysiological pathways that lead to recurrent middle lobe atelectasis: obstructive and nonobstructive. Recurrent or fixed right middle lobe opacification is almost pathognomonic for MLS however, lingular involvement is common due to similar anatomic and physiological burdens. in a case series involving 12 patients with nontuberculous middle lobe atelectasis secondary to extensive compression by enlarged lymph nodes. It was first identified clinically in 1948 by Graham et al. Middle lobe syndrome (MLS) is a relatively uncommon clinical entity that is under-recognized in clinical practice. Explain the importance of collaboration and communication among the interprofessional team to ensure appropriate evaluation and management of patients with middle lobe syndrome.Review the treatment and management options available for middle lobe syndrome.Describe the evaluation of middle lobe syndrome.Identify the etiology of middle lobe syndrome.This activity describes the etiology, epidemiology, evaluation, and management of patients with middle lobe syndrome and emphasizes the role of an interprofessional team in providing thorough and appropriate management to affected patients. Healthcare providers will need a high index of suspicion based on clinical history in identifying this syndrome. Recognizing the constellation of signs and symptoms that constitute this syndrome may be a diagnostic challenge. ![]() Middle lobe syndrome is a relatively uncommon clinical entity that is under-recognized in clinical practice.
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