Right Middle Lobe Syndrome Treatment & Management
- Author: Nemr S Eid, MD, FAAP, FCCP; Chief Editor: Michael R Bye, MD more...
Long-term follow-up of children with right middle lobe syndrome (RMLS) shows that most patients do not experience recurrent or persisting symptoms. This indicates that the first line of treatment in all cases is conservative medical management, except in cases involving neoplastic origin and those with bronchiectasis.
Chest physical therapy and postural drainage are the hallmarks of therapy.
Treat the asthmatic child with aggressive anti-inflammatory therapy such as inhaled steroids. Consider systemic steroids. Guidelines for the diagnosis and management of asthma have been established.
Provide the patient with chest physical therapy and postural drainage. In unresponsive patients or patients who have a predisposition to airway colonization, an appropriate antibiotic, as determined by a bronchoalveolar lavage (BAL) culture, should be added to their regimen.
Patients with fungal infections (eg, histoplasmosis) or tuberculous infections who have hilar adenopathy and complete blockage of their right middle lobe should be treated aggressively. The addition of systemic corticosteroids may be necessary.
Lobectomy is indicated in cases of malignancy and bronchiectasis that are unresponsive to medical therapy.
Only perform lobectomy when right middle lobe syndrome is associated with systemic symptoms such as failure to thrive, persistent cough, and recurrent fever or when chronic infection threatens the remainder of the lung.
Avoid bronchography because of potential risks to the patient unless surgery is seriously considered; therefore, always explore high-resolution CT imaging as an alternative.
Consultations may include a pediatric pulmonologist and/ or a pediatric infectious disease specialist.
Springer C, Avital A, Noviski N, et al. Role of infection in the middle lobe syndrome in asthma. Arch Dis Child. 1992 May. 67(5):592-4. [Medline].
Liu J, Chen SW, Liu F, Li QP, Kong XY, Feng ZC. The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest. 2015 Apr 1. 147(4):1013-9. [Medline].
[Guideline] Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of asthma. 2008 Jan. [Full Text].
Priftis KN, Mermiri D, Papadopoulou A, et al. The role of timely intervention in middle lobe syndrome in children. Chest. 2005 Oct. 128(4):2504-10. [Medline].
Halliday HL, Ehrenkranz RA, Doyle LW. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2009 Jan 21. CD001146. [Medline].
Brown M, Lemen R. Bronchiectasis. Kendig's Disorders of the Respiratory Tract in Children. Philadelphia, Pa: WB Saunders Co; 1998. 150-2.
Priftis KN, Anthracopoulos MB, Mermiri D, et al. Bronchial hyperresponsiveness, atopy, and bronchoalveolar lavage eosinophils in persistent middle lobe syndrome. Pediatr Pulmonol. 2006 Sep. 41(9):805-11. [Medline].
Torkian B, Kanthan R, Burbridge B. Diagnostic pitfalls in fine needle aspiration of solitary pulmonary nodules: two cases with radio-cyto-histological correlation. BMC Pulm Med. 2003 Sep 8. 3(1):2. [Medline]. [Full Text].