right middle lobe syndrome
DESCRIPTION
a case of shortness of breathTRANSCRIPT
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We did indeed offer the Trust to the Heavens and the Earth and the Mountains; but they refused to undertake it, being afraid thereof: but man undertook it;- He was indeed unjust and foolish
ه� �� ن إ�� ه� ن ا ن� إ�� ن� � ن�ا ن� ن� ن� ن� ن�ا ن� إ� ن� ن� ن� ن� ��ن ن� ن�ا ن� ن� إ� �ن �ن ن� ��ن ن� ن� ن ن�ا ن! إ" ن#ا إ$ ن% ن�� إ& ن' ��ن ن� ن�� إ) ن�� ن�ا ن� %� ن�ى ن* ن+ ن� ن�ا ��ن ن� � ن�ا ن, ن- ن* ��ا ن إ��ل�� ه�و ن0 ل�ا ه�و ن1 ن� ن2ا
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The story
A 68 year old Saudi gentleman , a known case of diabetes and chronic atrophic rhinitis presented to us with
•Chronic and recurrent cough
• Shortness of breath
•On and off since 5 years
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Chest X-Ray
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Lateral view
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On examination
vitals stable with SPO2 94
lung examination showed bilateral rhonchi
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Investigation CT Chest right middle lobe bronchial
thickening with
distal collapse
hilar mediastinal
lymphadenopathy with suspicion of malignancy
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InvestBronchscopy
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Brochoscopy
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Investigations BAL negative for malignancy
BAL culture –no growth
Bronchial biopsy showed asthma related changes
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Investigation Hb 14,
WBC 6.9
Differential showed 16.8% of eosinophils with AEC of 1160
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Final diagnosis
Right Middle lobe Syndrome
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How do you treat ?
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Management
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Aggressive asthma treatment
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In exacerbations
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Lobectomy for bronchiectasis/malignancy
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Management Chest physiotherapy and postural drainage
Treat asthma aggressively
Antibiotics in exacerbation
Lobectomy for malignancy/bronchiectasis