Right Middle Lobe Syndrome

Right Middle Lobe Syndrome General Details:
Right Middle Lobe Syndrome is a confusing term.
There is no consistent clinical definition.
Commonly described as non-obstructive atelectasis of the Right Middle Lobe (RML) of lung.
Most common in children with a history of asthma or atopy.
One version is Lady Windermere syndrome due to Mycobacterium avium complex infection.

Diagnosis:
A right middle lobe syndrome (RMLS) diagnosis is mainly based on the presence of atelectasis of the RML of long duration.
Need to rule out an acute right middle lobe pneumonia with repeat chest X-ray in 3-4 weeks of initial onset.
Some authorities suggest the diagnosis is made only after a patent bronchus is confirmed.

Investigation (Radiology):
Bronchography - patent bronchus & often associated bronchiectasis.
Bronchoscopy - shows a patent bronchus.
High resolution CT (HRCT) chest - employ if bronchiectasis is suspected.
Serial chest X-rays.

Investigation - Chest Xray:
Characterized by a wedge-shaped density that extends anteriorly & inferiorly from the hilum of the lung.
Feature is best visualized on lateral chest X-ray.
Variable volume loss in RML, which may fluctuate over time

Investigations (Other):
ESR
Full blood count (FBC)
Fungal serology
Immunoglobulins
Lung function tests
Tuberculin skin test

Image: from Wikipedia by Samir under GNU Free Documentation License.
Tags: Asthma - Atelectasis - Atopy - Bronchography - Bronchoscopy - Chest X-ray - ESR - HRCT - Mycobacterium avium complex - Right Middle Lobe Syndrome
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