Right middle lobe syndrome caused by eosinophilic mucoid impaction in adults

Ha Won Hwang; Joo-Hee Kim; Suk Yeon Kim; Sun Ho Lee; Soo Haeng Lee; Sunghoon Park; Yong Il Hwang; Seung Hun Jang; Ki-Suck Jung; In Jae Lee

doi:10.4168/aard.2016.4.2.149

Journal List > Allergy Asthma Respir Dis > v.4(2) > 1059171

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Hwang, Kim, Kim, Lee, Lee, Park, Hwang, Jang, Jung, and Lee: Right middle lobe syndrome caused by eosinophilic mucoid impaction in adults

Case Report

Allergy, Asthma & Respiratory Disease 2016; 4(2): 149-153.

Published online: 31 March 2016

DOI: https://doi.org/10.4168/aard.2016.4.2.149

Right middle lobe syndrome caused by eosinophilic mucoid impaction in adults

Ha Won Hwang¹, Joo-Hee Kim¹

, Suk Yeon Kim¹, Sun Ho Lee¹, Soo Haeng Lee¹, Sunghoon Park¹, Yong Il Hwang¹, Seung Hun Jang¹, Ki-Suck Jung¹, In Jae Lee²

¹Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

²Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Correspondence to: Joo- Hee Kim. Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea. Tel: +82-31-380-3972, Fax: +82-31-380-3973, luxjhee@gmail.com

Received 25 August 2015 Revised 1 October 2015 Accepted 26 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Right middle lobe syndrome (RMLS) is defined as a transient or recurrent, chronic collapse of the middle lobe of the right lung by certain pathologic conditions. RMLS is a relatively uncommon condition having multiple etiologies and various clinical presentations. Two patients were referred to Hallym University Sacred Heart Hospital, one for the treatment of coughing and the other for the treatment of pneumonia. A diagnosis of RMLS was identified through X-ray and computed tomography image evaluation for each condition. Bronchoscopy revealed mucus obstruction in the right middle lobe bronchus. Biopsy of the aspirated mucus showed mucus containing many eosinophils and Charcot-Leyden crystals. After removal of impacted mucus, clinical and radiological improvements were observed in both patients. Therefore, eosinophilic mucus impaction can be considered a potential cause of RMLS, irrespective of any underlying asthmatic symptoms.

Keywords: Right middle lobe syndrome, Eosinophilic mucus, Chronic cough, Pneumonia

Figures and Tables

Fig. 1

(A, B) Chest X-ray shows consolidation in right middle lobe. (C) Chest computed to-mography shows soft tissue density obstructing right middle lobe bronchus.

Fig. 2

(A, B) Bronchoscopic examination reveals thick mucus plug with mucosal edema and focal hemorrhagic changes in right middle lobe bronchus. (C) Biopsy specimen of mucus plug shows chronic inflammation with mucus containing many eosinophils (H&E, ×400).

Fig. 3

(A, B) Chest X-ray shows consolidation in right middle lobe (RML). (C) Chest computed tomography shows an endobronchial lesion obstructing RML medial segmental bronchus and (D) lobar consolidation with internal low attenuated lesion in RML.

Fig. 4

(A) Bronchoscopic examination reveals yellowish and thick mucus plug at the right middle lobe bronchus. (B) Biopsy specimen of mucus plug shows many eosinophils and Charcot-Leyden crystals (H&E, ×400).

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ORCID iDs: Joo-Hee Kim
https://orcid.org/http://orcid.org/0000-0002-1572-5149
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