Middle lobe syndrome: Twenty years’ surgical experience

Abstract

<b>Introduction:</b> Middle lobe syndrome (MLS) is defined as recurrent or chronic collapse of the middle lobe. This study evaluates clinico-radiological features and surgical management of MLS. <b>Methods:</b> Clinical data of 157&nbsp;patients with obstructive MLS&nbsp;or non-obstructive&nbsp;MLS were collected from the patients’ records between 2000 and 2020 in our Thoracic surgery departement in Abderrahmen Mami hospital, Tunisia. <b>Results:</b> We studied 91 females (58%) and 66 males(42%) with a mean age of 33,18 +/- 19,85. The most common clinical features were chronic cough with productive&nbsp;sputum(90%), recurrent infection(55%) and intermittent hemoptysis(50%). Bronchoscopy was performed&nbsp;for all patients showing an endobronchial&nbsp;lesion in 7,64% of cases, an extrinsic compression&nbsp;in 5 %, an avascular white membranous structure in 3% and&nbsp;no evidence of a central obstructive lesion for the other patients. Middle lobe collapse was seen in chest computed tomography in all cases.&nbsp;Bronchiectasis was the most common etiological factor in these series (53,5%). Hydatic cyst was not rare and was final pathology in 28% of patients. Ten patients (6,36%) had intraluminal carcinoid in middle lobe bronchus. Minor findings included tuberculosis (5%), broncholithiasis (3%) and peribronchial inflammation. All patients underwent middle lobe resection. They survived surgery with minor peri- and postoperative complications. <b>Conclusion:</b> MLS can be treated effectively with middle lobe resection, with low mortality rate and favorable outcome. Bronchiectasis is the most common histological finding. Hydatid cyst isn’t a rare cause of MLS due to&nbsp;its high prevalence in north africa countries.