EpistemisLocalized and fixed expiratory wheezing in the right middle lobe
Specialty: Respiratory.
Why it occurs
- Middle lobe syndrome secondary to obstructive bronchogenic carcinoma of the right middle lobar bronchus (the fixed and irreversible narrowing of the bronchial lumen due to tumor growth generates a single and constant whistling tone perfectly localized on auscultation of the right anterior region of the thorax, which is not modified by cough or bronchodilator treatment)
- Intrabronchial foreign body aspirated and lodged in the right middle lobar bronchus
- Extrinsic compression of the right middle lobar bronchus due to inflammatory, tuberculous or tumor hilar lymphadenopathy (due to its long and thin anatomy that makes it prone to compression).
Initial workup
Computed tomography (CT) of the chest with intravenous contrast; Flexible bronchoscopy (essential for direct visualization of the right middle lobar bronchus, taking biopsies, bronchial brushing or foreign body extraction); sputum cytology; Spirometry with flow-volume curve.
red flags
Fixed localized wheezing in the right middle lobe associated with recurrent hemoptoic sputum or frank hemoptysis, progressive dyspnea on exertion, active smoking with progressive weight loss, or image of persistent right middle lobar atelectasis on control chest x-ray.
Standard management
- Treatment with regular bronchodilators is not effective in resolving mechanical physical obstruction
- Methylprednisolone — 40 mg intravenously if there is associated peritumoral inflammatory mucosal edema that worsens the obstruction
- Definitive management requires bronchial endoscopic intervention, dilation, or stent placement.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 3
- Treatment options
- 3