What is Wrong With My Right Lung?

Sayed K. Ali MD, FACP and Hammad Bhatti MD

An 89 year old man with a history of hypertension, diabetes, COPD and remote tobacco use presented to clinic for an evaluation of a right middle lobe mass.  The patient had been previously treated at an outside hospital for community-acquired pneumonia, where a CT chest revealed a 2.7 x 3.8 cm right middle lobe mass with hilar lymphadenopathy and bronchiectasis (Figures 1 & 2).  A bronchoscopy was subsequently pursued showing partial narrowing of the middle lobe bronchus and was non diagnostic of a neoplastic process.  CT imaging of his brain, abdomen and pelvis also failed to show a malignant process.   A PET scan did not show any areas of increased uptake.   Ultimately a CT-guided biopsy of the lung lesion revealed some focal fibrosis with chronic inflammatory cell infiltrate.  

 

 

---

Click here to view answer

References:
1. Blaivas AJ, Strauss W. Middle lobe syndrome in the left lower lobe in chronic obstructive pulmonary disease. Prim Care Resp J 2009;18(4):331-333 
2. Gudjartsson T, Gudmundsson G. Middle lobe syndrome: a review of the clinicopathological features, diagnosis and treatment. Respiration 2012;84(1):80-6

Authors:

Sayed K. Ali MD, FACP.  Faculty, Internal medicine, Palliative care. Orlando VAMC. Associate Professor University of Central Florida, College of Medicine.

Hammad Bhatti MD.  Faculty, Pulmonary Critical Care, Orlando VAMC. Assistant Professor, University of Central Florida, College of Medicine.