[The middle lobe syndrome in pediatrics. A study of 27 cases].

OBJECTIVE

The purpose of this study was to analyze the features, treatment and evolution of middle lobe syndrome (MLS) or atelectasis syndrome in children.

PATIENTS AND METHODS

Between 1992 and 1996, all cases of MLS seen in our center by our staff were followed by using a prospective study protocol.

RESULTS

Twenty-seven patients were studied. The average age at the onset of MLS was 3 years 1 month +/- 2 years 4 months. Recurrent pneumonia was seen in 66.7% and 44.4% had asthma and/or elevated IgE. Acute symptoms at the onset were seen in 74% of the cases, with persistent cough being the most common symptom. Complementary procedures (chest X-rays, computed tomography scans, bronchoscopy, V/P scintigraphy) demonstrated 16 cases of pneumonia, 13 of atelectasis, 7 of bronchiectasia and 4 cases with other abnormalities. Infectious etiology was the most predominant (66.7%) Bronchoscopy was performed in 8 cases and 5 of them improved immediately. Pulmonary scintigraphy was normal in those patients with radiographic residual images. All patients were initially medically treated. Three were lobectomized. Twenty-three patients healed. The younger the patient at the onset of MLS the better the cure rate.

CONCLUSIONS

Infectious causes were dominant in our series. Early and aggressive medical treatment may cure the majority of cases. Bronchoscopy is helpful in the diagnosis and as a therapeutic procedure. Scintigraphy could be helpful as a resolution criterion when there are residual radiographic images.