Abstract
A 60-year-old Indian woman who was suffering from recurrent pneumonia presented with major haemoptysis and a right-sided pleuritic chest pain. Initially the patient required resuscitation to optimise her haemodynamic parameters while oxygenation remained satisfactory. An urgent computed tomography pulmonary angiogram revealed right middle lobe syndrome which constitutes chronic collapse of the middle lobe accompanied by bronchiectatic changes. Angiography identified an abnormal bronchial artery and venous shunting which was embolised satisfactorily. Subsequently she underwent bronchoscopy which was unremarkable. Her post-operative course was uneventful and patient was discharged home. During the post-operative follow-up patient remained stable and was discharged from out-patient clinic after two years.
Highlights
Middle lobe syndrome (MLS) is an uncommon disease involving the right middle lobe and/or left lingula
It is estimated that 90% of haemoptysis originates from the bronchial tree circulation which may commonly be associated with anomalous bronchial artery [5]
In this case the malformation of the bronchial artery was ruled out, the chronic infection, bronchiectasis and atelectasis imposed an abnormal vasculature to the regional anatomy of the bronchial artery and its branches which can be labelled as a culprit for acute haemoptysis
Summary
Middle lobe syndrome (MLS) is an uncommon disease involving the right middle lobe and/or left lingula. This syndrome which is characterised by the chronic collapse of the middle lobe and bronchiectasis [1] has been previously described in both adults and children [2,3]. Clinical manifestations are in consistence with that of pulmonary infection symptoms; that is cough as well as fever and less commonly dyspnoea, haemoptysis and pleuritic chest pain. Patients may remain asymptomatic, a wide spectrum of signs and symptoms has been reported [1].
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