Middle Lobe Disease

The anatomic arrangement of lymph nodes about the middle lobe bronchus, the moderate enlargement of which produces bronchial occlusion, appears to be the reason for inflammatory disease limiting itself to the right middle lobe.

Most patients with inflammatory disease limited to the middle lobe give a history of an acute pneumonic onset, the symptoms of which never clear completely or recur after the cessation of penicillin therapy.

The changes in the frontal x-ray film of the chest are often negligible in patients with bronchiectasis limited to the middle lobe and the symptoms are often much more severe than one might expect from the amount of pulmonary tissue involved.

The technique of dividing the hilar structures of the middle lobe distal to a clamp, removing the clamp, and then treating the vessels and bronchus individually has been found to give satisfactory results when adherent lymph nodes made the usual isolation and individual ligation method too hazardous.

Right middle lobectomy is the only satisfactory method of treatment of inflammatory lesions of the middle lobe with bronchial obstruction which fail to clear by medical therapy.