Isolated Disease of the Middle Lobe and Lingula

¹ Department of Surgery, Jefferson Medical College
² Heart Association of Southeastern Pennsylvania

1. The records of 77 patients with isolated disease of the middle lobe or lingula compiled over a 14-year period at the Jefferson Medical College Hospital were reviewed.

2. There were 44 men and 33 women, the greatest incidence being between the ages of 40 and 70.

See Table in the PDF File

3. The symptomatology is similar to that of chronic respiratory disease in general with cough, sputum production, chest pain and hemoptysis encountered in the majority of cases.

4. The radiologic appearance of the middle lobe syndrome is that of chronic atelectasis and pneumonitis. It is always necesary to obtain a right lateral x-ray film because the atelectatic middle lobe or lingula may be hidden on conventional posteroanterior views.

5. Exploratory thoracotomy was carried out on all patients. In most cases, only the involved lobe was removed.

6. Sixteen different pathologic entities causing the middle lobe or lingular disease were encountered.

7. The clinical diagnosis of "middle lobe syndrome" should be made when the middle lobe bronchus is obstructed, regardless of whether the obstruction is intra- or extraluminal. Thirty-six of our cases fit this description. The exact etiology can only be ascertained in the pathology laboratory.

8. The term "middle lobe disease" should be used in cases of chronic non-specific pneumonitis secondary to bronchial obstruction by chronically inflamed lymph nodes. Sixteen of our cases are of this type.

9. Cases of isolated middle lobe abnormality that occur without evidence of bronchial obstruction should not be included in either of the above categories.