Right Middle Lobe Syndrome in Asthmatic Children

Abstract

The inpatient records of all children up to 19 years of age admitted to Thomas Jefferson University Hospital from July 1968 to January 1978 with diagnosis of bronchial asthma were reviewed. Among 475 admissions, radiologic evidence of right middle lobe atelectasis or pneumonia was found in 21 patients encompassing 28 admissions (5.85% of all admissions). Thirteen patients (62%) had sinus roentgenograms consistent with sinusitis. Bronchoscopy and bronchogram were not deemed necessary. Conservative management, including theophylline preparations (100%), beta-agonists (89%), antibiotics (79%), corticosteroids (57%), postural drainage (75%), chest physical therapy (25%), and potassium iodide (18%), was employed. Mean length of hospitalization was 8.5 days, with a range of 3–16 days. Nineteen of the 28 admissions resulted in reexpansion of the middle lobe at discharge, and in 7, reexpansion occurred within the following 6 months. Two patients were lost to follow-up. Patients with more than one admission responded each time to medical treatment. Middle lobe syndrome in asthmatic children is not uncommon and may be recurrent and usually responds to conservation management. Invasive procedures, such as bronchoscopy, bronchogram, and lobectomy, should be reserved for those patients with persistent disease unresponsive to medical management.