Article Text

CONSERVATIVE MANAGEMENT OF MIDDLE LOBE SYNDROME ASSOCIATED BRONCHIECTASIS
  1. A Fernandes1,
  2. V Silva1,
  3. M Henriques1,
  4. A Amador1
  1. 1Pediatrics Department, Hospital de Nossa Senhora Do Rosrio, EPE, Barreiro, Portugal

Abstract

Right middle lobe syndrome RMLS includes a spectrum of clinical and radiological presentations, from persistentrecurrent atelectasis to pneumonitis and bronchiectasis. RMLS may be due to intra or extraairway causes in children its usually secondary to bronchial inflammatory stenosis. The gold standard for diagnosis is highresolution CT scanning bronchofibroscopy is important to evaluate the degree of stenosis and, sometimes, as a therapeutic tool. The management of RMLS has been conservative, but bronchiectasis has been an indication to surgery.

We present the case of a sixyearold girl with a history of recurrent respiratory tract infections since 15months of age, who had RMLS secondary to stenosis of the medial branch of RML bronchus. She was diagnosed with bronchiectasis located to RML and lingula by chest CT scanning four years after the initial symptoms. We started conservative management with chest physiotherapy, inhaled corticosteroids and antibiotic therapy for acute exacerbations she has also been receiving influenza and pneumococcal immunisations.

The indications for surgery of RMLS associated bronchiectasis have been limited in recent decades because the newer diagnostictherapeutic techniques and more potent antibiotics have made conservative management possible. On the other hand, it has been suggested that bronchiectasis in children may be a dynamic process and that the majority of children without progressive underlying disorder may improve with appropriate medical treatment. RMLS usually improves as the child grows older and the diameter of RML bronchus enlarges, even when it is stenosed. Regarding this, we discuss the diagnosis, treatment and followup of RMLS.

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