Problemi non correnti
La sindrome del lobo medio nel bambino
MIDDLE LOBE SYNDROME
GIOVANNI NOCERINO
Unità di Broncopneumologia, Fisiopatologia Respiratoria Pediatrica, Ospedale SS. Annunziata, Napoli
Gennaio 2005 - pagg. 37 -43
Abstract
Due to its peculiar anatomical structure, the middle lobe is at high risk for atelectasis, which
can be partial or total, with or without parenchymal infiltration. Particularly in cases of partial
or “pure” atelectasis, antero-posterior X-ray may not be sufficiently informative and a latero-
lateral X-ray may be necessary to show the typical triangular opacity. Middle lobe atelectasis
can be transitory, recurrent or persistent, and is caused by mechanical (foreign body),
inflammatory (hilar adenopathy, bronchiectasis, broncopneumonia) or functional (asthma) obstruction.
The “middle lobe syndrome” is now rare due to the sharp decline of tuberculosis and
the decreased incidence and severity of suppurative lung disease, but still needs to be known
and promptly recognised.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Kwon KI, Myers JL, Swensen SJ, et al.
Middle lobe syndrome: a clinicopatological
study of 21 patients. Hum Pathol 1995;26(3):
302-7.
2. Brock R, et al. Tuberculous mediastinal lymphadenitis in chilhood. Secundary effects of the lungs. Guy’s Hosp Rep 1937;87:295.
3. Graham EA, et al. Middle lobe syndrome. Postgrad Med 1948,4:29.
4. Culiner MM. The right middle lobe syndrome. A non-obstructive complex. Dis Chest 1966:1-57.
5. Danielson GK, et al. Middle lobe bronchiectasis. Report of an unusual familiar occurrence. J Am Med Ass 1967;8:605.
6. Springer C, Avital A, Noviski N, et al. Role of infection in the middle lobe syndrome in asthma. Arch Dis Child 1992;67(5):592-4.
7. Livingstone GL, Holinger LD, Luck SR. Right middle lobe syndrome in children. Int J Pediatr Otorhinolaryngol 1987;13(1):11-23.
8. Gudmunddson G, Gross TJ. Middle lobe syndrome. Am Fam Phisician 1996;53(8): 2547-50.
9. Lederman H. The clinical presentation of primary immune deficiences. Clinical Focus on Primary Immune Deficiences 2002;1(10):1
10. Ring-Mrozik E, Hecker WC, Nerlich A, et al. Clinical findings in middle lobe syndrome and other processes of pulmonary shrinkage in children (atelectasis syndrome). Eur J Pediatr Surg 1991;1(5):266-72.
11. Gaston B. Pneumonia. Pediatr Rev 2002; 23:132.
12. Lodha R, Puranik M, Natchu UC, et al. Recurrent pneumonia in children: clinical profile and underlyng causes. Acta Paediatr 2002; 91(11):1170-73.
13. Vaughan D, Katkin JP. Chronic and recurrent pneumonias in children. Semin Respirat Infect 2002;17:72-84.
14. Wald ER. Recurrent pneumonia in children. Adv Pediatr Infect Dis 1990;5:183-203.
15. Owayed A, Campbell DM, Wang EE. Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med 2000; 154:190-7.
16. Bertelsen S, Struve-Christensen E, Aasted A, et al. Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment the socalled middle lobe syndrome. Thorax 1980; 35(6):449-52.
17. Heffelfinger JD, Davis TE, Gebrian B, et al. Evaluation of children with recurrent pneumonia diagnosed by World Health Organitation criteria. Pediatr Infect Dis J 2002;21:108- 12.
18. Kuhn JP, Brody AS. High-resolution CT of pediatric lung disease. Radiol Clin North Am 2002;40:89-110.
19. Woroniecka M, Ballow M. Office evaluation of children with recurrent infection. Pediatr Clin North Am 2000;47:1211-24.
20. Sacco O, Mattioli G, Silvestri M, et al. Tecniche diagnostiche strumentali e chirurgiche. In: Rossi G (ed). Pneumologia Pediatrica Milano: McGraw-Hill, 1998:79-87.
21. Perez-Ruiz E, Perez-Frias J, Martinez-Gonzalez B, et al. Pediatric bronchoscopy. Analysis of a decade. An Esp Pediatr 2001; 55(5):421-8.
22. Rock MJ. The diagnostic utility of bronchoalveolar lavage in immunocompetent children with unexplained infiltrates on chest radiograph. Pediatrics 1995;95(3):373-7.
23. De Boeck K, Willems T, Van Gysel D, et al. Outcome after right middle lobe syndrome. Chest 1995;108(1):150-2.
24. Youssef Fasheh W, Esquinas Rychen G. The middle lobe syndrome in pediatrics. A study of 27 cases. An Esp Pediatr 1998;49(6): 582-6.
25. Shears BJ. Recurrent pneumonia in children. Pediatr Ann 2002; 31:1098.
26. Mc Dowell KM, Kercsmar CM. Evaluating the child with recurrent unilobar pneumonia. J Respir Dis 1994;15:633.
27. Avital A, Godfrey S, Bortz R, et al. Gavaging the infant lung. Pediatr Pulmonol 2002; 34:388.
28. Holmgren NL, Cordova M, Ortuzar P, et al. Role of flexible bronchoscopy in the re-expansion of persistent atelectasis in children. Arch Broncopneumol (Spain) 2002;38(8):367- 71.
29. Parul B Patel, Nelson L Turcios. Pneumonia that recurs: your diagnostic challenge. Medical Economics Company, Inc. Contemp Pediatr 2003;20(3):82-106.
30. AgasthianT, Deschamps C, Trastek VF, et al. Surgical management of bronchiectasis. Ann Thorac Surg 1996;62:976-80.
31. Case Records of Massachusetts General Hospital. N Engl J Med 2002;347:13.
2. Brock R, et al. Tuberculous mediastinal lymphadenitis in chilhood. Secundary effects of the lungs. Guy’s Hosp Rep 1937;87:295.
3. Graham EA, et al. Middle lobe syndrome. Postgrad Med 1948,4:29.
4. Culiner MM. The right middle lobe syndrome. A non-obstructive complex. Dis Chest 1966:1-57.
5. Danielson GK, et al. Middle lobe bronchiectasis. Report of an unusual familiar occurrence. J Am Med Ass 1967;8:605.
6. Springer C, Avital A, Noviski N, et al. Role of infection in the middle lobe syndrome in asthma. Arch Dis Child 1992;67(5):592-4.
7. Livingstone GL, Holinger LD, Luck SR. Right middle lobe syndrome in children. Int J Pediatr Otorhinolaryngol 1987;13(1):11-23.
8. Gudmunddson G, Gross TJ. Middle lobe syndrome. Am Fam Phisician 1996;53(8): 2547-50.
9. Lederman H. The clinical presentation of primary immune deficiences. Clinical Focus on Primary Immune Deficiences 2002;1(10):1
10. Ring-Mrozik E, Hecker WC, Nerlich A, et al. Clinical findings in middle lobe syndrome and other processes of pulmonary shrinkage in children (atelectasis syndrome). Eur J Pediatr Surg 1991;1(5):266-72.
11. Gaston B. Pneumonia. Pediatr Rev 2002; 23:132.
12. Lodha R, Puranik M, Natchu UC, et al. Recurrent pneumonia in children: clinical profile and underlyng causes. Acta Paediatr 2002; 91(11):1170-73.
13. Vaughan D, Katkin JP. Chronic and recurrent pneumonias in children. Semin Respirat Infect 2002;17:72-84.
14. Wald ER. Recurrent pneumonia in children. Adv Pediatr Infect Dis 1990;5:183-203.
15. Owayed A, Campbell DM, Wang EE. Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med 2000; 154:190-7.
16. Bertelsen S, Struve-Christensen E, Aasted A, et al. Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment the socalled middle lobe syndrome. Thorax 1980; 35(6):449-52.
17. Heffelfinger JD, Davis TE, Gebrian B, et al. Evaluation of children with recurrent pneumonia diagnosed by World Health Organitation criteria. Pediatr Infect Dis J 2002;21:108- 12.
18. Kuhn JP, Brody AS. High-resolution CT of pediatric lung disease. Radiol Clin North Am 2002;40:89-110.
19. Woroniecka M, Ballow M. Office evaluation of children with recurrent infection. Pediatr Clin North Am 2000;47:1211-24.
20. Sacco O, Mattioli G, Silvestri M, et al. Tecniche diagnostiche strumentali e chirurgiche. In: Rossi G (ed). Pneumologia Pediatrica Milano: McGraw-Hill, 1998:79-87.
21. Perez-Ruiz E, Perez-Frias J, Martinez-Gonzalez B, et al. Pediatric bronchoscopy. Analysis of a decade. An Esp Pediatr 2001; 55(5):421-8.
22. Rock MJ. The diagnostic utility of bronchoalveolar lavage in immunocompetent children with unexplained infiltrates on chest radiograph. Pediatrics 1995;95(3):373-7.
23. De Boeck K, Willems T, Van Gysel D, et al. Outcome after right middle lobe syndrome. Chest 1995;108(1):150-2.
24. Youssef Fasheh W, Esquinas Rychen G. The middle lobe syndrome in pediatrics. A study of 27 cases. An Esp Pediatr 1998;49(6): 582-6.
25. Shears BJ. Recurrent pneumonia in children. Pediatr Ann 2002; 31:1098.
26. Mc Dowell KM, Kercsmar CM. Evaluating the child with recurrent unilobar pneumonia. J Respir Dis 1994;15:633.
27. Avital A, Godfrey S, Bortz R, et al. Gavaging the infant lung. Pediatr Pulmonol 2002; 34:388.
28. Holmgren NL, Cordova M, Ortuzar P, et al. Role of flexible bronchoscopy in the re-expansion of persistent atelectasis in children. Arch Broncopneumol (Spain) 2002;38(8):367- 71.
29. Parul B Patel, Nelson L Turcios. Pneumonia that recurs: your diagnostic challenge. Medical Economics Company, Inc. Contemp Pediatr 2003;20(3):82-106.
30. AgasthianT, Deschamps C, Trastek VF, et al. Surgical management of bronchiectasis. Ann Thorac Surg 1996;62:976-80.
31. Case Records of Massachusetts General Hospital. N Engl J Med 2002;347:13.