Middle Lobe Of Lung Research Articles

Effect of High-frequency Ventilation on the Development of Alveolar Edema in Premature Monkeys at Risk for Hyaline Membrane Disease

High-frequency oscillatory ventilation (HFOV) permits adequate gas exchange but avoids the large phasic pressure-volume excursions of conventional mechanical ventilation (CMV); such avoidance may reduce the lung injury associated with hyaline membrane disease (HMD). We hypothesized that premature monkeys ventilated from birth with HFOV would have reduced lung injury compared to those assigned to CMV. Macaca nemestrina were delivered at 134 days (80% of term gestation) and ventilated from the first breath with either HFOV (n = 10) or CMV (n = 10). The mean airway pressure (Paw) was kept at 15 cm H2O pressure in HFOV animals; in CMV animals Paw was increased from 8 cm H2O at 2 h to 13 cm H2O at 6 h to prevent hypoxemia. At the conclusion of the 6-h experiment the HFOV animals had better oxygenation (p less than 0.05) and less evidence of HMD by chest radiograph (p less than 0.05). At 6 h of age a piece of the right middle lung lobe was removed, divided, and placed in fixatives for light and transmission electron microscopy. The lungs were subsequently inflated to 30 cm H2O pressure, and the right lower lobe was rapidly frozen in situ for morphometric studies. The proportion of peripheral lung tissue occupied by clear alveoli was greater in HFOV animals (66.3 +/- 14.8%) than in those assigned to CMV (44.2 +/- 16.9%, p less than 0.01); less alveolar debris and fluid was present in the HFOV animals (12.7 +/- 9.9%) compared with CMV animals (27.1 +/- 12.5%, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

A CASE OF ACUTE PULMONARY EMBOLISM AFTER SKIN GRAFT

A case of acute pulmonary embolism after skin graft is reported. A 69-year-old female underwent skin graft for a burn on the right knee on May 11, 1989. On the sixth operative day, she suddenly developed anterior chest pain and dyspnea after micturition, and followed by shock condition. Pulmonary embolism was strongly suspected and the anticoagulant and thrombolytic therapy was immediately initiated. Prostaglandin E1 was added by drip infusion. Pumonary scintigram 7 days after the onset showed blood flow defects in the middle and lower lobe of the right lung. A diagnosis of acute pulmonary embolism was made. The patient made favorable progress after medical treatment and pulmonary scintigram 37 days after the onset revealed a marked remission. She was discharged on June 30. In conclusion, acute pulmonary embolism should be cosidered as one of the critical complications after operation and early diagnosis followed by immediate initiation of the treatment are important.

DORSAL PERITONEOPERICARDIAL MESOTHELIAL REMNANT AS AN AID TO THE DIAGNOSIS OF FELINE CONGENITAL PERITONEOPERICARDIAL DIAPHRAGMATIC HERNIA

A new radiographic finding associated with feline congenital peritoneopericardial diaphragmatic hernias (CPDH) was identified and is presented in this paper. This finding represents the dorsal border of the hernia and when present appears on the lateral thoracic radiograph. Descriptively, the finding was called the dorsal peritoneopericardial mesothelial remnant (DPMR). In order to determine the recognizability and possible impact of this radiographic finding, thoracic radiographs of 10 cats with CPDH were randomly mixed with 20 other feline thoracic radiographic studies, which included 4 normal cats and 16 cats with a variety of primary cardiac disorders. Eight radiologists were instructed to identify the presence or absence of the DPMR. They were told that the DPMR connected the dorsal aspect of the caudal pericardium to the diaphragm at the site of the CPDH, and that the DPMR would be present on the lateral radiograph ventral to or superimposed over the area of the caudal vena cava. The reviewers were then asked to describe any other radiographic features that were consistent with a diagnosis of CPDH. At least 6 of the 8 reviewers identified the DPMR as being present in each of the 10 cats. In 17 instances, reviewers used the presence of the DPMR as the only radiographic finding in reaching a diagnosis of CPDH. In 4 instances of CPDH, the DPMR was not recognized by the reviewers, but other radiographic features were used that led them to a correct diagnosis of CPDH. In 2 separate instances, a reviewer misidentified pleural effusion/thickening within the interlobar fissure between the middle and caudal lung lobes as being the DPMR. In 7 false‐positive diagnoses of CPDH, reviewers did not identify the presence of the DPMR but diagnosed CPDH based on perceived abnormalities in cardiac shape. Each of these cats had feline cardiomyopathy and not CPDH. It is concluded that in the absence of more typical thoracic radiographic features of feline CPDH, the presence of a DPMR on the lateral radiograph should make one suspicious of CPDH as the cause of cardiac silhouette enlargement or contour abnormality.

原発巣と肺転移巣切除をほぼ同時期に行った舌下腺原発腺様嚢胞癌の１例

In this report, we described the details of a lung metastasis of adenoid cystic carcinoma arising in the sublingual gland.A 49-year old male had the chief complaint of swelling at the left submandibular region, a malignant tumor was suspected by clinical diagnosis using CT scan, echography, and RI imaging scan. This showed an irregular centric solid mass in submandibular region. Breast X-ray also gave a suspicion of lung metastasis lesion by a phantom breast X-ray of posterioranterior finding, fuji computed tomography and CT scan. The patient has undergone resection of the primary tumor and middle lobe of the right lung. Irradiation of 50 Gy for the submandibular region and immunochemotherapy were followed postoperatively. Patient is alive and tumor free for 2 years 7 months. Histological examinations of both submandibular and lung lesions revealed adenoid cystic carcinoma (grade I, T2aN0M1, stage IV).

The mechanism of nitrous oxide-induced changes in pulmonary vascular resistance in a dog model of left atrial outflow obstruction

Nitrous oxide has been reported to increase pulmonary vascular resistance (PVR) in patients with pulmonary hypertension secondary to mitral stenosis. Additional data suggest this response involves sympathetic stimulation because the increase in PVR can be prevented by a-adrenergic and ganglionic blockade. Whether or not active pulmonary vasoconstriction occurs remains unclear. This study was designed to more fully characterize the influence of N 2O on pulmonary hemodynamics during left atrial outflow obstruction (LAO). Responses in an in situ blood-perfused lung lobe were compared with those in the remaining intact lung of six dogs anesthetized with pentobarbital, 30 mg/kg, and morphine, 1.5 mg/kg, and prepared for measurement of peak left ventricular (LV) pressure, LV end-diastolic pressure (LVEDP), LV dP/dt, systemic arterial and pulmonary arterial (PA) pressures, and cardiac output (CO). The pulmonary artery branch supplying the left middle lung lobe was cannulated and perfused at a constant rate with warmed blood. LAO was produced by filling the balloon of a Foley catheter positioned in the left atrium (LA) with enough saline to increase PA pressure by 50%; the balloon was subsequently left filled for the entire protocol. Measurements were first obtained during ventilation with 67% N 2, and 33% O 2. The inspired gas was then changed to 67% N 2O and 33% O 2 for 10 minutes, and then returned to the N 2/O 2 mixture. Once baselines had been reestablished (about 10 minutes), phentolamine, 0.75 mg/kg, was administered, and the response to 10 minutes of N 2O again observed. N 2O did not change vascular resistance in the isolated lobe, but increased intact-lung PVR. The pressure differential across the lung (mean PA pressure — LA pressure) was not altered by N 2O in either the isolated or intact lung. CO (pulmonary blood flow) was slightly but significantly reduced by N 2O while the perfusion flow rate remained constant. Concomitantly, systemic vascular resistance (SVR) and LVEDP both rose; the increase in LVEDP was not accompanied by an increase in LV dP/dt max Following phentolamine treatment, N 2O did not change hemodynamics in either the intact lung or isolated lobe, nor did it alter CO, SVR, or LVEDP; however, it did produce a fall in LV dP/dt max This study suggests that under conditions of experimental LAO, nitrous oxide increases PVR primarily by reducing pulmonary blood flow. The findings do not support an active pulmonary arteriolar vasoconstriction by N 2O.

Right upper lobe versus right middle lobe: differentiation with thin-section, high-resolution CT.

A new method was developed to differentiate the upper lobe from the middle lobe of the right lung with thin-section, high-resolution computed tomography. In the upper lobe, a medial subsegmental bronchus of an anterior segmental bronchus is always located lateral to the corresponding artery. In the middle lobe, a medial subsegmental bronchus of a lateral segmental bronchus and a superior and inferior subsegmental bronchus of a medial segmental bronchus are always located medial to the corresponding artery. In other words, the anatomic relationship between the subsegmental bronchi and the corresponding pulmonary arteries in the upper lobe is opposite to that in the middle lobe. One hundred seventeen cases, including 54 cases of lobar volume loss, were reviewed with this method, and in each case it was possible to differentiate the upper lobe from the middle lobe without the contiguous section analysis.

EFFECT OF DEPENDENCY VERSUS NONDEPENDENCY ON LUNG LESION VISUALIZATION

Paraffin blocks and mineral oil were used as a model to determine the effect of dependency versus nondependency on radiographic visualization of lung lesions in lateral thoracic radiographs. It was concluded that the increased opacity of the material surrounding the lesion, not contact between the heart and the lesion, was responsible for the inability to detect lung disease in the dependent lung. The results were tested in dogs with pneumonia in the right middle lung lobe. When the dog was in right lateral recumbency, the dependent right lung was increased in opacity and decreased in volume and the pulmonary lesion was difficult to detect. When the dog was in left lateral recumbency, the nondependent right lung was increased in volume and decreased in opacity and the pulmonary disease was clearly visible. A single recumbent lateral radiograph must not be used to assess a dog with suspected lung disease because lesions in the dependent lung lobes may not be detected.

Intravascular macrophages in lungs of pigs infected with Haemophilus pleuropneumoniae.

Pigs were inoculated intratracheally with a virulent or an avirulent isolate of Haemophilus pleuropneumoniae serotype 5 and sacrificed during the first 24 hours post-inoculation. Intravascular macrophages were examined by electron microscopic and morphometric techniques. Samples of lung were taken from regions with no macroscopic lesions (Zone 0), 2.5 to 3.0 cm from lesions (Zone 1), and from the immediate edge of lesions (Zone 2). Those pigs inoculated with the avirulent isolate did not develop lesions. Pigs given the virulent isolate consistently developed necrohemorrhagic lesions in the dorsolateral aspect of the caudal and middle lung lobes. Relative volumes of intravascular macrophages in Zones 1 and 2 increased with increased time post-inoculation; in pigs given the avirulent isolate, intravascular macrophage volume decreased with increased time post-inoculation. Cytoplasmic volume to nuclear volume ratios for macrophages in Zone 2 from pigs with necrohemorrhagic lesions progressively increased with increased time post-inoculation. Enlarged intravascular macrophages had large nuclei, prominent nucleoli, and abundant cytoplasm. Increased cytoplasmic volume was the result of increased numbers of lysosomes, phagosomes, rough and smooth endoplasmic reticulum, and large Golgi complexes. Pigs inoculated with the virulent bacteria had IV macrophages with large phagosomes that contained necrotic cell debris and fibrin. Macrophages with phagosomes were more frequent in the 6-, 9-, and 24-hour sample periods of pigs with lesions than in any other group. Intercellular adhesion plaques (ICAP) were present between IV macrophages and subjacent endothelial cells. ICAP's increased in length with increased time post-inoculation in Zones 1 and 2 from pigs with necrohemorrhagic lesions. In later sample periods, multiple closely associated and interlacing IV macrophages formed a discontinuous layer over endothelial cells in Zone 2 samples near necrohemorrhagic lesions. These results suggest that the intravascular macrophage population changes from immature macrophages to mature macrophages or immature epithelioid cells within 24 hours after inhalation of a virulent Haemophilus pleuropneumoniae. Furthermore, intravascular macrophages likely function to clear cellular and acellular debris from the blood in pneumonic conditions.

ACQUIRED CYSTIC BRONCHIECTASIS IN THE DOG: A CASE HISTORY REPORT

A 9‐year‐old neutered female mixed breed dog was examined for productive coughing, gagging, increased respiratory effort and restlessness. In survey chest radiographs a soft tissue opacity was present in the right middle lung lobe. In horizontal‐beam radiographs, it was apparent that the opacity was a thin‐walled cyst containing air and fluid. Peribronchial infiltration and bronchial dilation were present in all lung lobes. At necropsy, a diagnosis of chronic bronchitis and bronchiolitis and cylindrical and cystic bronchiectasis was made. Acquired bronchiectasis may result from any disease process which weakens the bronchial wall or obstructs drainage. Three forms of bronchiectasis have been described in man: cylindrical, saccular and cystic. Cylindrical bronchiectasis is tubular distention of larger, thick‐walled bronchi; saccular bronchiectasis is circumscribed outpocketing of intermediate‐sized bronchi and cystic bronchiectasis is a more pronounced manifestation of saccular bronchiectasis in terminal bronchi. Cylindrical and saccular bronchiectasis have been described in the dog; cystic bronchiectasis has not been described in the dog. Generalized bronchiectasis is an incurable condition due to the irreversible bronchial pathologic changes. Focal bronchiectasis can be surgically corrected by lobectomy and the prognosis is good. Aggressive antibiotic therapy should be used to treat chronic bronchitis in an effort to prevent bronchial destruction and development of bronchiectasis.

原発性マクログロブリン血症の1剖検例

An autopsy case of primary macroglobulinemia with gastro-duodenal multiple ulcers is reported. The patient was a 68-year-old man who complained of edema of bilateral legs when he was exposed to cold since 65 years old, and after hospitalization he developed multiple skin ulcers of bilateral legs, persistent diarrhea and pathological fracture of the fifth lumbar vertebra.Serological studies revealed an increase in amount of monoclonal IgM (kappa) up to 5200mg/dl. Cryoglobulin was detected in the serum and CIq binding activity amounted to 39%. Urinary Bence-Jones protein was positive. Bone marrow aspiration revealed the proliferation of plasmablastlike cells. The patient died due to pneumonia and gastrointestinal bleeding 3.5 years after the onset of this disease.Autopsy reveale d gastro-duodenal multiple ulcers. Hepatosplenomegaly and lymph node swelling were not found. The middle lobe of the right lung contained a walnut-sized abscess.Microscopically plasmocytoid lymphocytes were found to infiltrate into almos t all organs, especially into the bone marrow. Some of these infiltrating cells contained PAS-positive, intranuclear and intracytoplasmic inclusion bodies, and PAS-positive eosinophilic homogeneous material was found to occlude the lumen of some of the submucosal capillaries and lymphatics in almost all organs, especially in the digestive tract.Gastro-duodenal multiple ulcers seem to have been caused as a result of the occlusion by the same material of submucosal capillaries and lymphatics.An immunofluorescent study, peroxidase-anti-peroxidase procedure and histochemical analysis revealed that this material is composed of monoclonal IgM (kappa) with an admixture of C3complement and phospholipid, Persistent diarrh ea of which this patient complained may be due to the occlusion by eosinophilic material of submucosal capillaries and lymphatics of intestine.Of various factors involved in the formation of this materi al, the deposition of IgM may be a most important one, and in addition, the precipitation of cryoglobulin, C3 complement and of phospholipid can be enumerated.It was exceedingly rare in cases of primary macroglobulinemia that IgM-positive materials were deposited, as noted in the present study, in the capillaries and lymphatics throughout the whole body.

Early development of human lung.

Two old conceptions on the development of the human lung, one of ‘stem and branch’, and the other of ‘eparterial’, do not seem to be reasonable to the present author. The lingual segment of the upper lobe of the left lung must be a portion corresponding to the middle lobe of the right lung.

Glioblastoma multiforme with extraneural metastases in the absence of previous surgery

A 63-year-old man was found to have an intracerebral glioblastoma multiforme and preoperative roentgenographic evidence of a mass in the middle lobe of the right lung. Because of the rarity of extraneural metastases from glioblastoma, especially in the absence of prior surgery, the lesions were considered to be separate neoplasms until death. The histologic appearance of the lung tumor obtained at autopsy was identical to the cerebral tumor. Additional metastases were found to bronchial lymph nodes and a lumbar vertebra. This case demonstrates that a glioblastoma can spontaneously metastasize extraneurally. Invasion of the glioblastoma into the lumen of a blood vessel was demonstrated within the primary tumor. Embolization of cells to the lung and beyond is the suspected mode of spread.

Amoebic pericarditis.

A case of suppurative amoebic pericarditis is presented. Abscesses were demonstrated in both right and left lobes of the liver. The pericardial sac was shown radiologically to communicate with both a right middle lobe lung abscess and an abscess in the left lobe of the liver. Perforation of a liver abscess into the pericardial cavity is a rare complication of amoebiasis. According to Oschner and De Bakey (1943) and Macleod, Wilmot and Powell (1966) it occurs in less than 2 per cent of cases of amoebic liver abscess. A 35-year-old black male was admitted to hospital with a two-month history of bilateral pleuritic chest pain and a cough, productive of blood-stained sputum. The initial chest radiograph demonstrated cardiomegaly with left ventricular enlargement (Fig. 1). A localized bulge was present on the left cardiac border, suggestive of a left ventricular aneurysm, which was not confirmed on cardiac screening. Injection of carbon dioxide into the right atrium was not diagnostic of pericardial effusion.

Pulmonary Changes After Temporary Ischemia of Varying Duration

In 84 white female Wistar rats, the upper (or middle) lobe of the right lung was subjected to temporary ischemia of 5, 10, 15, 30, 90, 300 and 360 minutes. Paraplast®-embedded sections were examined 1, 2, 3, 5, 7, and 10 days after the procedure. We found an intraalveolar extravasate lasting for 3 days. The protein and erythrocyte content of the extravasate depends upon the duration of the preceding temporary ischemia. The appearance of the extravasate is considered to be due to postischemic insufficiency of the terminal vascular system with an increase in permeability according to the duration of the ischemia. The extravasate phase is followed by an atelectatic phase, the duration of which correlates well with the duration of the preceding temporary ischemia. In our opinion this is due to a destruction of the surfactant by the intraalveolar extravasate followed by delayed replacement of the surfactant because of a postischemic insufficiency of the surfactant-producing pneumocytes II. Following temporary ischemia, necroses can be observed as follows: interalveolar septa (10 – 15 min.), bronchial epithelium (30 – 90 min.), smooth muscles (300 – 360 min.). The time of temporary ischemia after which necroses of the septa occurred was not only extremely short but also equal in length for all component cell types. Consequently, the assumption is made that a viscosity increase following a hemoconcentration caused by an extravasation of plasma led to a circulatory restriction, or stasis, which in turn prolonged the state of ischemia. After reinflation, enlargement of the alveolar air spaces was observed. This appears to be due to necrosis in a number of alveolar walls. Bei 84 weißen, weiblichen Wistar-Ratten wurde der Ober (oder Mittel-) lappen der rechten Lunge einer temporären Ischämie von 5, 10, 15, 30, 90, 300 und 360 Minuten ausgesetzt. In Paraplast® eingebettete Präparate des rechten Ober (bzw. Mittel-) lappens, der übrigen rechten Lunge sowie der linken Lunge wurden nach 1, 2, 3, 5, 7 und 10 Tagen untersucht. Wir fanden ein über 3 Tage andauerndes intraalveoläres Extravasat im rechten Ober(bzw. Mittel-) lappen, welches in seinem Gehalt an Eiweiß und Erythrocyten eine Abhängigkeit von der Länge der Ischämie erkennen ließ. Dieses Extravasat war offenbar Folge einer postischämischen Insuffizienz der terminalen Strombahn, verbunden mit einem von der Dauer der temporären Ischämie abhängigen Anstieg der Gefäßdurchlässigkeit. Dem Extravasat folgte eine Atelektase, deren Dauer bis zur Wiederentfaltung eine auffallende Beziehung zu der vorausgegangenen Ischämie zeigte. Diese Beobachtung wird von uns so gedeutet, daß es nach einer Zerstörung des alveolären Oberflächenfilms durch das intraalveoläre Extravasat zu einem verzögerten Ersatz des Films infolge einer postischämischen Insuffizienz der den Film produzierenden Pneumozyten II kommt. Nach temporärer Ischämie fanden sich Nekrosen der Alveolarsepten (10–15 Min.), der Bronchusepithelien (30–90 Min.) und der glatten Muskulatur (300–360 Min.). Die Wiederbelebungszeit der Septen war hierbei nicht nur sehr kurz, sondern auch für alle am Septumaufbau beteiligten Zelltypen einheitlich. Es wird deshalb angenommen, daß es infolge einer Viskositätserhöhung nach einer durch Plasmaextravasation bedingten Hämokonzentration zu einer Verminderung oder einem Stillstand der Durchblutung gekommen war, wodurch die Ischämie verlängert wurde. Nach der Wiederentfaltung des Lungenlappens wurde eine Erweiterung der Alveolen-tragenden Lufträume beobachtet, die Folge von Nekrosen einzelner Alveolarsepten zu sein scheint.

Pulmonary nodule caused by a living Brugia malayi-like filaria in an artery.

Abstract A mature, infertile, female filaria was found in a small pulmonary artery near an infarct-like lesion in the middle lobe of a right lung surgically removed from a middle-aged jute-mill operator, who, after long residence in Indian, returned to Scotland because of sudden chest pain, hemoptysis, and radiographic findings suggestive of bronchial carcinoma. The worm was identified as a Brugia species closely resembling B. malayi, and the lesion was interpreted as resulting from obstructive arterial changes caused by the living worm. The findings are discussed in relation to the filarial etiology of eosinophilic lung.

Intra pulmonary Vein Contributing a Segment of Venous Supply of Contralateral Lung

In a 23-month-old girl with asplenia and associated cardiovascular anomalies, the pulmonary venous system was of particular interest. The two major veins of the right lung joined in the mediastinum to form a single vein, which entered the left lung. In the left lung, this vein joined the upper end of a convex vein. From the lower end of the vein within the left lung a vein emerged into the mediastinum. On its way to joining the right of bilateral superior venae cavae, the latter vein received the vein of the middle lobe of the right lung. The phenomenon of the venous supply of one lung crossing the mediastinum and entering the contralateral lung is explained as an anomaly of the pulmonary venous system dating back to the time when the primordia of the two lungs was represented by a single specialized portion of the foregut. In a 23-month-old girl with asplenia and associated cardiovascular anomalies, the pulmonary venous system was of particular interest. The two major veins of the right lung joined in the mediastinum to form a single vein, which entered the left lung. In the left lung, this vein joined the upper end of a convex vein. From the lower end of the vein within the left lung a vein emerged into the mediastinum. On its way to joining the right of bilateral superior venae cavae, the latter vein received the vein of the middle lobe of the right lung. The phenomenon of the venous supply of one lung crossing the mediastinum and entering the contralateral lung is explained as an anomaly of the pulmonary venous system dating back to the time when the primordia of the two lungs was represented by a single specialized portion of the foregut.

Lobar pneumonia due to proteus infection in a previously healthy adult

This report describes a forty-six year old Negro woman who entered the hospital with fever and consolidation involving most of the upper lobe and a small portion of the middle lobe of the right lung. After an initial decrease in temperature on penicillin therapy, fever recurred and persisted for nineteen days. Thirteen bacteriological specimens were obtained from the respiratory tract on admission and thereafter, including eleven specimens of sputum; all revealed Proteus either in pure growth or as the predominant organism. Therapy with six antimicrobial agents failed to induce improvement. Following the administration of large doses of kanamycin there was a fall in the temperature and white blood cell count, roentgenographic clearing and disappearance of Proteus from the sputum. Our patient differed from those previously described in that she was free of prior pulmonary and systemic disease, had not received antibiotics, had no other demonstrable focus of Proteus infection and had negative blood cultures.

Choice of Anesthetic Technique in Patients With Acute Pulmonary Disease

A 75-year-old woman was admitted to the hospital two days following an intertrochanteric fracture of her left hip. She had been hospitalized in another hospital for the two-day period. Past history revealed an episode of pneumonia of the middle lobe of the right lung four years prior to admission and pneumonia of the lower lobe of the right lung six months prior to admission. She had had asthma for several years. She had daily a productive cough producing thick tenacious sputum, quantity unknown; she denied having dyspnea. Physical examination revealed a reasonably healthy old woman. There were rales throughout her left lung field, and chest x-ray films revealed a marked tracheal deviation and apparent near-total collapse of the left lung (Figure). On the basis of traditional concepts that inhalation anesthesia may be injurious to the lungs and not tolerated well by patients with lung disease, regional anesthesia was strongly recommended

Right Middle Lobe Syndrome in Children

<h3>To the Editor:—</h3> In a recent article, "Right Middle Lobe Syndrome in Children" (<b>197</b>:8, 1966), reference was made to the value of bronchograms in children "whose posteroanterior and lateral x-rays showed... equivocal changes such as blurred heart border, increased bronchovascular markings etc...." No mention was made of films taken in lordotic view which, in my opinion, has proved, both in adults and in children, useful in recognizing or evaluating parenchymal infiltrative pathology in the middle lobe of the right lung. This holds specifically in cases in which the ambiguous or inconclusive signs in the right lower lung field don't allow a more distinct diagnostic approach. In these cases a film taken in lordosis frequently produces a typical wedgeshaped density in the basal central zone of the right lower lung field representing a parenchymal involvement of the middle lobe. Thus the lordotic view should be part of the x-ray examination

Right Middle Lobe Syndrome in Children

A series of 30 children with the right middle lobe syndrome had cough and asthmatic-like wheezing. Pneumonia or bronchitis characterized by recurrent localization in the middle lobe of the right lung were constant findings. Respiratory symptoms were refractory to usual treatment. Abnormal findings on chest x-rays and bronchograms showed complete or partial atelectasis of right middle lobe in all cases. In some children, decreased vital capacity with normal one-second forced expiratory volume and laboratory signs of infection were present. The condition appeared twice as frequently in girls as in boys, and symptoms usually began at 1 to 2 years of age, although diagnosis was rarely made before 6 years of age. Twenty-three of the 30 children were atopic, and 18 of the 30 had family histories of allergy. Treatment consisted of lobectomy in ten (all of whom improved considerably). On conservative medical management alone, this condition was controlled in ten, eight were unimproved, one was lost to follow-up, and one died.