right middle lobe syndrome

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a case of shortness of breath

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right middle lobe syndrome

  1. 1. We did indeed offer the Trust to theHeavens and the Earth and theMountains; but they refused toundertake it, being afraid thereof:but man undertook it;- He wasindeed unjust and foolish
  2. 2. The storyA 68 year old Saudi gentleman , a known case of diabetes andchronic atrophic rhinitis presented to us with•Chronic and recurrent cough• Shortness of breath•On and off since 5 years
  3. 3. Chest X-Ray
  4. 4. Lateral view
  5. 5. On examination vitals stable with SPO2 94 lung examination showed bilateral rhonchi
  6. 6. Investigation CT Chest right middle lobe bronchial thickening with distal collapse hilar mediastinal lymphadenopathy with suspicion of malignancy
  7. 7. InvestBronchscopy
  8. 8. Brochoscopy
  9. 9. Investigations BAL negative for malignancy BAL culture –no growth Bronchial biopsy showed asthma related changes
  10. 10. Investigation Hb 14, WBC 6.9 Differential showed 16.8% of eosinophils with AECof 1160
  11. 11. Final diagnosisRight Middle lobeSyndrome
  12. 12. How do you treat ?
  13. 13. Management
  14. 14. Aggressive asthma treatment
  15. 15. In exacerbations
  16. 16. Lobectomy for bronchiectasis/malignancy
  17. 17. Management Chest physiotherapy and postural drainage Treat asthma aggressively Antibiotics in exacerbation Lobectomy for malignancy/bronchiectasis

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