Right middle lobe syndrome after upper lobectomy: Role of the bronchial angle.

Autor:	Strollo DC; Department of Cardiothoracic Surgery, Thoracic Imaging, 6614University of Pittsburgh, Pittsburgh, PA, USA., Donnenberg VS; Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Hillman Cancer Research Pavilion, Pittsburgh, PA, USA., Madan S; IQVIA Biotech, Clinical Project Management, Gibsonia, PA, USA., Moran PL; UPMC Enterprises, Digital Solutions, Pittsburgh, PA, USA., Luketich JD; Department of Cardiothoracic Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA., Sanchez MV; Department of Cardiothoracic Surgery, Northwell Health Physician Partners, North Shore Long Island Jewish Medical Center, Staten Island, NY, USA.
Jazyk:	angličtina
Zdroj:	Asian cardiovascular & thoracic annals [Asian Cardiovasc Thorac Ann] 2023 Mar; Vol. 31 (3), pp. 215-220. Date of Electronic Publication: 2022 Dec 13.
DOI:	10.1177/02184923221144402
Abstrakt:	Background: Right middle lobe syndrome is part of a spectrum of relatively rare but serious conditions that may occur following right upper lobectomy. We aimed to assess whether the preoperative middle lobe bronchial angle on CT predicted patients at risk of developing middle lobe syndrome. Method: All patients who had a complete upper lobectomy over 4 years were retrospectively reviewed for clinical and imaging findings of middle lobe syndrome. Patients with previous lung surgery, preoperative chemo- or radiation therapy, or more extensive surgical resection were excluded. Patient demographics and symptoms, the surgical, pathologic and bronchoscopy reports, and pre- and post-operative chest imaging, to include 3D CT reconstructions and measurements of the middle lobe angles in a subset of patients, were retrospectively reviewed. Result: One hundred and twenty-eight patients met inclusion criteria. Ten (8%) had middle lobe syndrome based on symptoms and imaging features. Eight had severe middle lobe consolidation. Two had postoperative onset of wheezing, with middle lobe bronchial abnormality on CT. The pre- and postoperative middle lobe bronchial angles of 14 patients without middle lobe syndrome were compared to 10 patients with middle lobe syndrome. The middle lobe bronchus was completely obliterated postoperatively and could not be determined in 1 patient. There was no significant difference between the pre- and postoperative angles in patients with or without middle lobe syndrome. Conclusion: Middle lobe syndrome occurred in 8% of patients with right upper lobectomy. The preoperative middle lobe bronchial angle did not predict patients at risk for developing middle lobe syndrome.
Databáze:	MEDLINE
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