oa South African Medical Journal - Die middellobsindroom
The middle lobe syndrome is being studied extensively nowadays. The anatomy of the middle lobe and its bronchus with lymph gland arrangement, soft bronchial walls and the presence of infection, predispose to this syndrome. Diagnosis is confirmed by X-ray studies, especially the lordotic projection, where the typical triangular shadow is seen more easily. Tomography and bronchography are of value, the latter especially for the demonstration of bronchiectasis. Bronchoscopy is valuable not only as a diagnostic procedure, but also for therapeutic purposes. This paper reports a study of 25 cases of middle lobe syndrome. Symptoms of chronic cough, haemoptysis, pyrexial attacks and loss of weight are indications for the above-mentioned special investigations. Proved pulmonary tuberculosis was found in near contacts of most cases although Koch's infection was not proved in the majority of the cases studied. Sometimes the middle lobe syndrome was discovered acidentally in the absence of symptoms. A few cases cleared up spontaneously. Others remained unchanged, or became worse in spite of antibiotic treatment. In the latter group of cases, because of continuous bronchial obstruction, resection is indicated. It is as yet uncertain for how long conservative treatment should be continued before deciding on surgery.
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