Source: Annual Congress 2002 - Miscellaneous respiratory infections in children
Disease area: Paediatric lung diseases

Abstract

We have used the following criteria for diagnosing middle lobe syndrome (MLS) within our secondary/ tertiary service: [dsquote]Persistent or recurrent lower respiratory illness accompanied by persisting chest x-ray infiltrates and/ or chest signs in the region of the middle lobe over a 6 month period or greater[dsquote]. This abstract descibes the clinical characteristics and results of investigations in 33 consecutive children aged 1.0- 13.3 years diagnosed with MLS who underwent bronchoscopy as part of their evaluation. Twenty-two patients had physician diagnosed asthma poorly responsive to conventional therapies and all had symptoms of wet coughing +/- wheeze. Fibreoptic bronchoscopy identified branch pattern variants in four children, and one had significant tracheomalacia. Differential cell counts on the bronchoalveolar lavage often showed a predominance of neutrophils and 10 children grew pathogenic bacteria in BAL fluid. Haemophilus influenzae was the most frequently identified organism. Three patients had significant abnormalities of their immune function: poor functional antibody response to pneumococcus, cyclical functional neutrophil defect, poor oxidative burst.
These data highlight the heterogenous nature of MLS in childhood which should be considered early in the differential diagnosis of therapy resistant asthma. Further investigation of such cases might usefully identify underlying factors that are amenable to therapy.

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Citations should be made in the following way:
J. S. A. Lucas, S. L. Struthers, G. J. Connett (Southampton, United Kingdom). Middle lobe syndrome in children. Eur Respir J 2002; 20: Suppl. 38, 2098

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