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A patient with a history of hepatocellular carcinoma was found to have multiple pulmonary metastases. Staged treatments were combined into a single operation session in the hybrid theater, encompassing bronchoscopic microwave ablation of central right upper lobe lesions and uniportal surgical wedge resections of peripheral right middle lobe lesions. All lung metastases were successfully treated with adequate margin clearance. Microwave ablation under the guidance of electromagnetic navigation bronchoscopy in the hybrid theater is a novel contribution to the multimodal operative management of multiple pulmonary neoplasms. It is a unique choice for patients with multilobar, subcentimeter metastases, and with concerns about lung function preservation.

Emphysema can be examined quantitatively on high-resolution computed tomography (HRCT) by measuring the low-attenuation areas of the lung and has been associated with decrease in lung function in patients with COPD [1]. Previous studies have associated levels of air pollution with emphysema severity of the total lung [2, 3]. However, the relationship between inhaled particulate matter (PM) deposition in the lungs and the degree of emphysema at the lung lobar level remains poorly understood. We examined the association of lung lobe-deposited doses of PM2.5 (particles with a 50% cut-off aerodynamic diameter of 2.5 μm) with the extent of emphysema in different lung lobes of COPD subjects., The novelty of this study is that it identified the associations between PM2.5 deposition in the lung and the degree of emphysema in different lung lobes of COPD patients, especially in the right middle lobe and both upper lobes https://bit.ly/3k21ri0

We report a 33-year-old man who presented with recurrent right pneumothorax. Computed tomography (CT) showed the presence of a large bulla with a maximum diameter of 8 cm in the right middle lobe; he subsequently underwent bullectomy. Histopathology revealed that pulmonary parenchyma adjacent to the bulla represented nodular proliferation of clear cells characterized by a papillary structure resembling placental chorionic villi. Immunohistochemically, clear cells were positive for CD10, suggesting placental transmogrification of the lung (PTL). We reviewed 36 surgical cases of PTL, and only 2 cases (5.6%), including our case, were operated for spontaneous pneumothorax. Bullous lesions secondary to PTL tend to appear as unilateral large cystic masses in non-upper lobes, which is atypical for primary spontaneous pneumothorax (PSP). Although PTL is considered a very rare cause of secondary pneumothorax, we must carefully differentiate this condition.

Middle lobe torsion is an uncommon complication after right upper lobectomy. Clinical features are non-specific. CECT chest and diagnostic bronchoscopy are the essential investigations for the diagnosis. The treatment of choice is urgent re-exploration with either lobectomy or de-rotation with pneumopexy through thoracotomy or video assisted thoracoscopic approach based on the viability of lobe. Strong clinical suspiscion and early surgical intervention are the key points for success. This report highlights the role of video assisted thoracoscopic approach in the management of this rare complication.

The right middle lobe segments (RS4 and RS5) are very small and the technique for segmentectomy is rarely reported. Here, we report 3 cases of thoracoscopic RS4 segmentectomy with VVBA (V, vein; V, ventilation; B, bronchus; A, artery) method. The VVBA method for thoracoscopic segmentectomy is a simple, safe, and effective procedure for RS4 segmentectomy with clear procedural steps. It overcomes the difficulty in manipulation of incomplete lung fissures and simplifies the surgical procedures.

The aims were to study the pattern of right bronchial tree with multi-detector CT. 238 patients were enrolled. The three-dimensional bronchial tree images were acquired using the post-processing technique of CT. There were mainly four types for right superior lobe bronchial tree, i.e., (140/238, B1–B2–B3); (44/238, B1 + 2, B3); (28/238, B2, B3); (22/238, B1, B2 + 3). There were two types for right middle lobe bronchial tree, i.e. (229/238, B4, B5); trifurcation of right middle lobe bronchi (9/238). There were mainly four types for right inferior lobe bronchial tree, i.e., (135/238, B6, B7, B8, B9, B10); (42/238, B6, B7, B8, B10); (25/238, B6, B7, B8 + 9, B10); (21/238, B6, B7, B8-B9-B10). The present study describes variations in the anatomy of the right bronchial tree, and reveals that there were mainly four types for right superior lobe bronchial tree, two types for right middle lobe bronchial tree, and four types for right inferior lobe bronchial tree.

Pulmonary carcinoids originate from neuroendocrine cells of the lung and comprise 0.5%–5% of all lung malignancies. Endobronchial carcinoids are rare, low-grade malignant tumors that occasionally coexist with other infectious diseases, including tuberculosis and nontuberculous mycobacterial infection. We treated a 63-year-old woman who presented with a right middle lobe obstruction. A chest computed tomography scan demonstrated a mass-like lesion in the right middle lobe with mediastinal lymphadenopathy. She underwent an exploratory operation after 2 weeks of antibiotic treatment. The pathology revealed a right middle lobe bronchial carcinoid tumor and aspergillosis. Chest computed tomography scans have revealed no recurrence of the carcinoid or aspergillosis during the 5-year follow-up.

We report the thoracoscopic RS5 segmentectomy with VVBA (V, vein; V, ventilation; B, bronchus; A, artery) method and confirmed that the segmental plane visualized by vein-first resection is slightly narrower than the traditional artery-first resection.

We used the lung ultrasound score (LUSS) to analyze the ultrasound images and assess the lesions and aeration loss in 12 lung regions of 11 COVID-19 neonates born to mother with COVID-19 and 11 age- and gender-matched controls. In the COVID-19 group, 132 regions were reviewed and 83 regions (62.8%) detected abnormalities. Compared with controls, COVID-19 neonates showed more increased B-lines (83 regions), abnormal A-lines (83 regions), abnormal pleural line (29 regions) and subpleural consolidation (5 regions). among which 49 regions (37%) were normal, 73 regions (55%) scored 1, and 10 regions (8%) scored 2. The LUSS was significantly higher in COVID-19 group. All the lesions were bilateral, multiple regions involved, and mainly located in bilateral lower lobes and right middle lobe. The intra-observer and inter-observer reproducibility of LUSS were excellent. Lung ultrasound is a noninvasive and convenient method for the assessment of neonatal COVID-19 pneumonia and presents typical signs. LUSS provides valuable semi-quantitative information about the lesion distribution and severity.

Robotic-assisted thoracoscopic surgery has increased in popularity during the past two decades because it offers 3-dimensional optics, increased instrument and wrist flexibility compared to classical video-assisted thoracoscopic surgery, and, for patients, improved quality of life and shorter hospital stays compared to open surgery. In this video tutorial, we demonstrate a robotic-assisted thoracoscopic surgery lobectomy in a patient with a tumor in the right middle lobe. The patient had an excellent recovery with no perioperative or postoperative complications.

Middle lobe syndrome (MLS) is defined as recurrent or chronic collapse of the middle lobe of the right lung. Although it was first described in 1984 by Graham et al., yet there are limited reviews on MLS especially in children as a result of vast etiologies, wide spectrum of presentation and lack of a consistent clinical definition. Herein, we present a case of MLS in a 7-year-old child who was presented after suffering from repeated chest infections for more than 3 years. Keywords: Atelectasis, Lingual syndrome, Middle lobe syndrome

Reports of right middle lobe segmentectomy are rare. We report here that anatomical right middle lobe segmentectomy is a relatively simple surgical procedure and can achieve good expansion of the remnant lung for patients with a relatively large right middle lobe.

Background Lung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early-stage non-small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early-stage right middle lobe NSCLC. Methods Patients who underwent lobectomy or sublobar resection for stage IA right middle lobe NSCLC tumors ≤ 2 cm between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results database of 18 registries. Cox regression model analysis was used to evaluate the prognostic factors. The lung cancer-specific survival (LCSS) and overall survival (OS) rates between the two groups were compared. Results A total of 861 patients met our criteria, including 662 (76.9%) patients who underwent lobectomy and 199 (23.1%) patients who underwent sublobar resection. No statistical differences in LCSS and OS rates were identified between the groups of patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1-2 cm, lobectomy was associated with more favorable LCSS and OS rates compared to sublobar resection. Conclusion Lobectomy and sublobar resection deliver a comparable prognosis for patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1-2 cm, lobectomy showed better survival rates than sublobar resection.

We present the case of a 72-year-old man with hemoptysis after a thoracic projectile injury, which occurred while mowing the lawn. Chest radiograph followed by a computed tomography angiogram revealed a metallic foreign body in the right middle lobe of the lung. The patient underwent a right anterolateral thoracotomy where the object was successfully retrieved. The patient had an uneventful postoperative recovery.

We report herein a case of nonmalignant middle lobe atelectasis of the right lung resulting in significant stenosis of the airway. The new short self-expandable metallic stents (SEMS) were used to perform temporary stenting and expansion of the right middle lobe airway. SEMS have been used to treat airway obstructions in the trachea, as well as the right and left carina, but few studies have looked at placing SEMS at the level of the bronchi, especially right middle lobe bronchus.

A 53‐year‐old man was admitted to our hospital with a history of a right lung nodule which had gradually increased in size. Wedge resection of the right middle lobe using video‐assisted thoracoscopic surgery (VATS) was performed and revealed a yellowish, soft, well circumscribed nodule. Histological analysis confirmed the diagnosis of an uncommon lipolymph node. The patient recovered well from surgery, and there has been no recurrence in the lung for over one‐year of follow‐up. To the best of our knowledge, this is the first report of a lipolymph node in the lung., Lipolymph nodes are defined as enlargement of lymph nodes caused by abnormal accumulation of fat, due to mature, benign adipocytes within lymph node capsules. To the best of our knowledge, this is the first report of a lipolymph node in the lung. Although rare and benign, lipolymph nodes should be considered in the differential diagnosis of pulmonary nodules.

A 62-year-old woman was referred to the pulmonary office for an incidentally identified solitary pulmonary nodule. The patient underwent CT of the abdomen and pelvis for evaluation of epigastric abdominal pain and was found to have a pulmonary nodule in the lateral segment of the right middle lobe (

Objectives General thoracic surgeons must be familiar with anatomical variation in the pulmonary vessels and bronchi. Here, we analyzed the bronchovascular pattern of the right middle lobe (RML) and right lower lobe (RLL) of the lung using three-dimensional CT angiography and bronchography (3DCTAB). Methods We reviewed the anatomical patterns of the pulmonary vessels and bronchi in 270 patients using 3DCTAB images. Results The branching patterns of vessels and bronchi of RML and S6 were classified according to the number of stems. The single-stem type was the most common, except in the artery of the RML, for which the two-stem type was the most common. The artery and bronchus of S*, which is an independent segment between S6 and S10, were observed in 20.4% of cases. The branching pattern of A7 (B7) was classified into four types. The A7a (B7a) type was observed in 74.8% of cases, and was the most common. The branching pattern of the artery and bronchus of S8−10 was classified into five and three types, respectively. The A8 and A9 + A10 type, and the B8 and B9 + B10 type, were observed in 68.1 and 80.4% of cases, respectively, and were the most common types. The branching pattern of V8−10 was more complex than that of A8−10 and B8−10. Conclusion We explored the bronchovascular patterns of RML and RLL and their frequencies using a large number of 3DCTAB images. Our data can be used by thoracic surgeons to perform safe and precise lung resections. Electronic supplementary material The online version of this article (doi:10.1007/s11748-017-0754-4) contains supplementary material, which is available to authorized users.

A 66-year-old Caucasian female with a 40-pack-year history of smoking and chronic obstructive pulmonary disease presented for follow-up of synchronous multiple primary lung cancers: Stage IB left upper lobe adenocarcinoma and Stage IA right middle lobe (RML) squamous cell carcinoma. The patient was treated with left upper lobectomy and RML pulmonary wedge resection 5 years prior. Surveillance chest computed tomography showed an increase in the size of the subcarinal lymph node and right lymph node conglomerate encasing the right upper lobe pulmonary artery, consistent with metastasis. Fine-needle aspiration of level 4R lymph nodes was performed. Histology and immunohistochemical staining confirmed the diagnosis of small cell carcinoma. Consequently, the patient was placed on cisplatin/etoposide combination chemotherapy.

Meandering right pulmonary vein is a rare vascular anomaly that requires accurate diagnosis to avoid unnecessary procedures and unintended vascular injury during operation. We describe an unusual meandering right upper lobe pulmonary vein draining into the left atrium via the right middle lobe pulmonary vein.

Superior mediastinal and #11i lymph node (LN) metastases are adverse prognostic factors in patients with middle lobe lung cancer. We aimed to clarify the benefit of thorough lymphadenectomy by LN station or zone in middle lobe non-small-cell lung cancer (NSCLC).Among 295 patients who underwent pulmonary resection and thorough lymphadenectomy for primary right middle lobe (RML) NSCLC at two institutions, we enrolled 68 patients (33 men, 35 women) and retrospectively studied their data. We divided each N1 location (i.e., #10, #11s and #11i) into N1(-)N2(+) and N1(+)N2(+) and divided the #12m location into N1(+)N2(-), N1(-)N2(+) and N1(+)N2(+).Interlobar node involvement was rare in pN1 NSCLC when compared with that in other N1 nodes. Lymph node dissection (LND) was beneficial when the hilar zone (HZ)/interlobar zone (IZ) LNs were located at the intermediate point of the upper zones (UZs) and subcarinal zones (SCZs), with the therapeutic benefit at the SCZ being 2.8-fold higher than that at the UZ and 9.7-fold higher than that at the lower zone (LZ). Furthermore, LND evidently had greater therapeutic value for the SCZ than the UZ, which was compatible with skip N2 metastases.For middle lobe NSCLC, mediastinal LND should be considered a priority in the SCZ than in the UZ. Moreover, the HZ/IZ is central to unfavourable prognoses in patients with pN2 middle lobe NSCLC.

Massive hemoptysis is a medical emergency and needs immediate treatment. It occurs in a wide variety of pulmonary diseases and typically originates from the bronchial arteries. We herein report a very rare case of a patient bleeding from a right phrenic artery-to-pulmonary artery fistula accompanied with focal bronchiectasis in the right middle lobe of the lung. In this case, multi-detector computed tomography was useful for clarifying the etiology and the abnormal anastomosis and facilitated effective angiographic embolization.

Herein, we describe our experience in treating a case of primary pulmonary mucosa-associated lymphoid tissue lymphoma detected as a nodular opacity. A 79-year-old man was referred to our hospital. Computed tomography showed a nodular opacity measuring 20 mm in diameter with regular margins in segment 5 of the right middle lobe of the lung. Although the bronchoscopic brush cytology result was class III, the patient was tentatively diagnosed with suspected mucosa-associated lymphoid tissue lymphoma. A thoracoscopic right middle lobectomy was performed. The pathological findings showed nodular proliferation of small to medium-sized, mature-appearing atypical lymphoid cells, lymphoepithelial lesions, and vague follicles suggesting follicular colonization in some areas. The patient was diagnosed with low-grade small B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma. He has remained well to date, 23 months after surgery, without evidence of recurrence.

Pulmonary pneumatoceles are air-filled thin-walled spaces within the lung and are rare in adult cases of pneumonia. We report the case of a 74-year-old male who was admitted with a cough and sputum production. He had been treated with oral dexamethasone since a brain tumorectomy 6 months prior. Contrast-enhanced computed tomography (CT) of the chest revealed a large pneumatocele in the right middle lobe and peripheral pneumonic consolidation. Bronchoalveolar lavage was performed; cultures identified extended-spectrum β-lactamase (ESBL) producing Proteus mirabilis. A 4-week course of intravenous ertapenem was administered, and the pneumatocele with pneumonia resolved on follow-up chest CT. To the best of our knowledge, this is the first reported case of pulmonary pneumatocele caused by ESBL-producing P. mirabilis associated with pneumonia.

Polymorphous low-grade adenocarcinoma (PLGA) is a low-grade malignant infiltrative tumor of the minor salivary glands. According to data from PubMed (National Center for Biotechnology), one case of PLGA involving the left main bronchus and one case involving the right main and upper lobar bronchi have previously been reported. Here, we describe the first case of PLGA originating in the trachea with metastasis to the right middle lobe bronchus, all initially misdiagnosed as adenoid cystic carcinoma (ACC). It is particularly important to distinguish this tumor from other types of salivary gland tumors, especially ACC. Complete surgical excision is the curative treatment of choice for PLGA.

A 36-year-old man underwent FDG PET/CT to evaluate a lung mass in the right middle lobe. The mass on the early PET images that were acquired 50 minutes post-FDG injection had only minimally increased FDG activity with uptake ratio between the mass and mediastinal blood pool of 0.93. However, on the delayed images acquired 230 minutes post-FDG administration, this ratio increased to 3.0, which enabled better notion of the lesion. Pathological examination demonstrated a primary pulmonary mucinous adenocarcinoma.

A 28-year-old male with B-cell acute lymphoblastic leukemia presented to our pulmonary clinic with progressive dyspnea, cough, hemoptysis, and fever. Diagnostic bronchoscopy revealed white masses at the entrance of the right middle lobe bronchus and distal to the right main bronchus. Histopathological examination of the biopsy specimen showed those masses to be hyphae of Aspergillus.

Recently, several authors have reported stenting into the right upper lobe bronchus using bifurcated stents, but little has been reported on stenting into the right middle or lower lobe bronchus. We report a case with metastatic uterine leiomyosarcoma, who was successfully treated by rigid bronchoscopic intervention, including silicone Y-stenting on the carina between the right middle lobe bronchus and the lower lobe bronchus.

Background We review our experience with postoperative lung torsion with retained viability. Methods A total of 2165 patients underwent pulmonary resection (lobectomy or segmentectomy) at our institution between 1 January, 1986, and 31 March, 2017. Eight (0.3%, six males and two females: median age, 68 years) had lung torsion with retained viability. Results The right upper lobe was resected in seven patients, while the left upper segment was resected in one patient. The lung torsion with retained viability was the right middle lobe in seven patients and the left lingular segment in one patient. A bronchoscopic examination was performed in four patients to diagnose the pulmonary torsion; however, it demonstrated no specific findings. Subsequently, computed tomography (CT) was performed in all the patients, and lung torsion was diagnosed in all the patients based on the CT findings. None of the patients showed any symptoms when lung torsion was diagnosed in them. The diagnosis of pulmonary torsion was made at a median of 4 days (range, 1–22 days) after the initial surgery. Six patients underwent detorsion of the affected lung, while one patient had a lobectomy, and one patient received conservative management. The lungs of all patients in which detorsion was performed adequately re-expanded. Frequent pneumonia in the viable torsed lung was diagnosed as a cause of death in the one patient who received conservative management. Conclusion The timely decision to follow a surgical approach for lung torsion with retained viability can lead to a satisfactory outcome.

Although peribronchial lymphatic drainage of the lung has been well characterized, lymphatic drainage in the visceral pleura is less well understood. The objective of the present study was to evaluate the lymphatic drainage of lung segments in the visceral pleura. Adult, European cadavers were examined. Cadavers with a history of pleural or pulmonary disease were excluded. The cadavers had been refrigerated but not embalmed. The lungs were surgically removed and re-warmed. Blue dye was injected into the subpleural area and into the first draining visceral pleural lymphatic vessel of each lung segment. Twenty-one cadavers (7 males and 14 females; mean age 80.9 years) were dissected an average of 9.8 day postmortem. A total of 380 dye injections (in 95 lobes) were performed. Lymphatic drainage of the visceral pleura followed a segmental pathway in 44.2% of the injections (n = 168) and an intersegmental pathway in 55.8% (n = 212). Drainage was found to be both intersegmental and interlobar in 2.6% of the injections (n = 10). Lymphatic drainage in the visceral pleura followed an intersegmental pathway in 22.8% (n = 13) of right upper lobe injections, 57.9% (n = 22) of right middle lobe injections, 83.3% (n = 75) of right lower lobe injections, 21% (n = 21) of left upper lobe injections, and 85.3% (n = 81) of left lower lobe injections. In the lung, lymphatic drainage in the visceral pleura appears to be more intersegmental than the peribronchial pathway is—especially in the lower lobes. The involvement of intersegmental lymphatic drainage in the visceral pleura should now be evaluated during pulmonary resections (and especially sub-lobar resections) for lung cancer.

We herein report a rare surgical case of the right middle lobe vein draining into the inferior pulmonary vein. The anatomical abnormalities in pulmonary veins can have a serious impact on complications during pulmonary surgery. Surgeons must be aware of any variation in the pulmonary vessels, and preoperative assessment of pulmonary venous anomalies is important during pulmonary surgery.

Massive haemoptysis is life‐threatening. Management options include pharmacological treatment, bronchial artery embolization, surgical resection, and bronchoscopic interventions. As an alternative treatment method of controlling haemoptysis, endobronchial stent insertion has been performed in several pulmonary carcinoma patients. We presented an 89‐year‐old bronchiectasis patient who developed massive haemoptysis from the right middle lobe bronchus. Haemoptysis was not controlled by both pharmacological treatment and bronchial artery embolization. Two customized silicone stents with the one in the right middle lobe bronchus and another in the right intermediate bronchus were used to manage haemoptysis. One month after stents implantation, the stent inside the right intermediate bronchus was removed, another stent was left in the right middle lobe bronchus to continue occluding the bleeding passageway. Haemoptysis did not occur after silicon stents deployment. This may be the first case of receiving straight silicon stent implantation to manage massive haemoptysis from the right middle lobe bronchus.

Lobar torsion is well documented after pneumonectomy, but is very rare after lung transplant. To the best of our knowledge, this is the twelfth reported case of lobar torsion after lung transplant. In our case, bronchoscopies and chest radiographs were inconclusive; however, CT scan clearly demonstrated findings consistent with right middle lobe torsion. We review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition. We also propose that if a clinical picture could be secondary to torsion and bronchoscopies and chest x ray are inconclusive that a CT scan should be obtained as soon as possible since early recognition increases the likelihood of being able to successfully detorse the lung and avoid lobectomy.

Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications.

Background The aim of the present study was to determine the prevalence of anatomical transposition of the remaining right middle lobe after right upper lobectomy and the effect of this transposition on postoperative global pulmonary function. Methods We correlated the postoperative pulmonary anatomical change with the functional change in patients undergoing right upper lobectomy for lung cancer. To estimate the regional pulmonary function, we measured the regional volume of the lung using normal lung attenuation values (− 600 to − 910 Hounsfield units), known as the functional lung volume, by computed tomography. The position of the middle lobe was objectively evaluated using volume-rendering three-dimensional computed tomography lung models. Intraoperatively, middle lobes were not fixed with the lower lobes. Results Postoperatively, the middle lobe remained attached to the anterobasal segment in 24 patients, whereas it migrated cranially in the remaining 26 patients. The functional volume of the middle lobe changed by various degrees postoperatively (range: 9 to 171% of preoperative values, mean: 96 ± 34%), and this change was significantly associated with the global pulmonary function ( R = 0.5, p = 0.01). However, there were no significant differences between patients with and without middle lobe migration with respect to the postoperative functional volume of the middle lobe, the postoperative functional volume of the total lung, and global pulmonary function. Conclusion Right middle lobe transposition after upper lobectomy is not associated with the deterioration of pulmonary function, but unexpected deflation of the right middle lobe is. Strategies for preventing middle lobe deflation should be explored in the clinical setting.

Background:­ In this study, we aimed to present the outcomes of surgical treatment performed on nine pediatric patients with congenital lobar emphysema (CLE). Methods: Between March 1996 and February 2011, nine children (5 boys, 4 girls; mean age 19.9 months; range 40 days-6 years) diagnosed with CLE who underwent pulmonary resection in our clinic were retrospectively analyzed. The symptoms, localization of the emphysematous lobe, diagnostic work-up, treatment modality, morbidity and mortality rates, and length of hospital stay were reviewed. Results:­Dyspnea was present in all of the patients, but it was severe in four patients. Emphysema was detected in the right middle lobe in three patients, the left upper lobe in three patients, the right upper lobe in one patient, and the left lower lobe in one patient. In the ninth and final patient, both the upper and middle right lobes were diseased. For all of the patients, the affected lobes with congenital emphysema were resected. None had postoperative morbidity or mortality, and the mean postoperative length of hospital stay was 5.8 days (range, 3-7 days). Conclusion:­ Pulmonary resection in children is a treatment modality for CLE with low morbidity and mortality rates that eliminates the disease rapidly, safely and completely.

Purpose To reduce the redundant acquisition range and total radiation dose for planning appropriate "triple rule-out" CT angiography (CTA) for acute chest pain, we evaluated the detailed distribution of pulmonary thromboemboli (PTE) in subjects with acute PTE. Materials and methods Retrospective review of CTA n 75-subjects (48-females; 57±16years) with proven acute PTE was performed to determine whether PTE was present solely above the aortic arch or below the heart. Results 77% had PTE in the right upper lobe but none had PTE that were solely located higher than the aortic arch; 73% had PTE in the right middle lobe; 80% had PTE in the right lower lobe, but none had PTE that were solely located lower than the heart. 81% had PTE in the left upper lobe and 3% of them had PTE solely located higher than the aortic arch; both had PTE in the right upper, middle, and lower, and the left lower lobes. 75% had PTE in the left lower lobe, but none had PTE that were solely located lower than the heart. The acquisition length in limited CTPA in this population was reduced on average by 21.9% compared with full CTPA. Conclusions In subjects with acute PTE, there were none whose PTE was located solely in the upper lobes which were higher than the aortic arch, nor solely in the lower lobes which were lower than the heart. A limited range triple rule-out CTA protocol would decrease effective doses approximately 22% relative to full chest CTA and may help the physician find all PE present.

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary arteries and pulmonary veins that are most commonly associated with hereditary hemorrhagic telangiectasia (HHT). The authors report a case of lobar artery embolization for the treatment of diffuse PAVMs in a patient with HHT who was experiencing recurrent transient ischemic attacks despite anticoagulation and multiple previous embolizations. The right lower lobar and interlobar arteries were embolized to achieve complete occlusion of multiple PAVMs in the right lower lobe and right middle lobe. In conclusion, lobar embolization can be considered for the relief of neurologic symptoms in patients with diffuse PAVMs.

A 37-year-old patient who has never been to your hospital presents for shortness of breath. He reports a history of HIV but is not currently on treatment and does not know his last CD4+ count. His oxygen saturation is 94% on room air, and lung sounds are distant. His CXR shows possible interstitial markings in the right middle lobe, his LDH is 240, absolute lymphocyte count (ALC) is 2200 …

石川県済生会金沢病院放射線部, 金沢大学医薬保健研究域保健学系, Objective:: Preoperative evaluation of bronchovascular structures is useful for prevention of accidents in pulmonary lobectomy. The purpose of this study was to examine the frequency and multidetector computed tomographic (CT) appearances of bronchovascular anomalies between the right middle and lower lobes. Methods:: A total of 1116 consecutive chest CT examinations were analyzed in the present study. On display, the bronchovascular anomalies between the right middle and lower lobes were searched. When anomalous structures were observed, 3-dimensional images were reconstructed. Results:: Sixty-seven cases (6.0%) with anomalous findings were observed. In 20 cases (1.79%), the right middle lobe bronchus and artery supplied the lower lobe, whereas the lower lobe artery supplied the right middle lobe in 46 cases (4.12%). In 1 case (0.09%), the 2 patterns previously mentioned were observed concomitantly. Conclusions:: Anomalous bronchovascular structures between the right middle and lower lobes were identified by a multidetector CT with an incidence of 6.0%. Knowledge of the frequency and CT features is useful for preoperative CT evaluation. © 2009 Lippincott Williams & Wilkins.

Lobar emphysema in the neonate is usually congenital, resulting from cartilage deficiency causing bronchomalacia and distal air trapping. Acquired forms are usually associated with chronic lung disease or endobronchial obstruction such as mucus plugging. We report a pedunculated endobronchial polyp in a 2-month old ex-premature infant causing intermittent hyperinflation of the right middle lobe. The polyp was seen prolapsing in and out of the bronchus intermedius at bronchoscopy. Possible aetiological links with mechanical ventilation are discussed. We also emphasise the value of bronchoscopy prior to lobectomy in cases of congenital lobar emphysema (CLE).

Clinicians frequently see the “right middle lobe” referred to in radiology reports, textbooks, and medical journals. Yet, there is no “left” middle lobe to distinguish it from, save a rare patient with Kartagener syndrome. We do not refer to the lingula as the “left” lingula. “Right” adds nothing to our understanding of the anatomic position of the lobe. So “right” is redundant when talking about the middle lobe. Yet, PubMed has 5,266 right middle lobe references, and a Google Scholars search found 22,900 publications used the phrase in the past 161 years. Th at is the equivalent of the length of two and one-half football fi elds worth of wasted words in just a Google search, nevermind those found in radiology reports, textbooks, or Index Medicus references (in Calibri font size 12, “right” 5 1 cm 3 22,900 search results 5 228.99 m).

中葉からのリンパ流は，通常分岐部を経由し上縦隔へ向かうものが主体だが，上葉気管支周囲リンパ節（＃１２u）を経由し上縦隔へ向かうとの報告もある．当院では，中葉原発非小細胞肺癌（NSCLC）切除時に標準郭清（ND2a）に加え＃１２u郭清を選択的に行っているが，その意義は不明であり，その適否を検討した．対象は，１９８０年～２００４年までに完全切除施行の中葉原発NSCLC１３３例のうち，多発肺癌を除くND2aを行った８６例（＃１２u郭清/非郭清：４７/３９例）．リンパ節転移率は，N0/N1/N2：７６/９/１５％．＃１２u転移はN2症例２例のみで，多領域リンパ節転移を伴い予後不良であった．５生率は，＃１２u郭清/非郭清で６８/７８％であり有意差を認めなかった（P＝０.３２）．再発は２５例（２９％）に認め，＃１２u郭清群に有意に多かったが（P＝０.００１），＃１２uの局所再発は認めなかった．以上より，中葉原発NSCLCにおいて＃１２u郭清の効果は明らかでなく，意義はないものと考えられた．

Between May 1988 and July 2002, six patients with pneumonia due to diesel, animal, or vegetable oil aspiration were admitted to Kaohsiung Medical University Hospital. The purpose of this study was to demonstrate distinctive radiographic findings of oil-induced lipoid pneumonitis on initial serial chest roentgenograms and high-resolution computerized tomography (CT) scans. Initial chest roentgenograms (n = 6), CT scans (n = 6), and roentgenography and CT follow-up studies were analyzed retrospectively by two chest radiologists and two surgeons, focusing on the pattern and distribution of parenchymal abnormalities. The most common location was the right middle lobe, followed by the right lower lobe, the left lower lobe, and the lingular lobe. Follow-up chest roentgenograms (n = 6) showed complete disappearance of the parenchymal lesions in only one patient and partial decrease in the extent of lesions in five patients. Lipoid pneumonia presents non-specific findings on chest roentgenography. It is commonly located in both lower and the right middle lobes. On high-resolution CT, the lesions appear most commonly as areas of consolidation, ground-glass attenuation mixed with paving pattern, and poorly defined nodules.

This case report describes a solitary fibrous tumour presenting as a pedunculated mass arising from an almost completely atretic right middle lobe of lung. The intraoperative findings and pathologic diagnostic criteria used are described. To our knowledge, this is the first case report of a solitary fibrous tumour associated with partial lung atresia.

A 53-year-old man with bleeding from a sternal mass associated with a toxic syndrome. Computed tomography (CT) revealed a destructive sternal mass, bilateral pleural effusion and an endobronchial lesion in the right middle lobe bronchus. Immunohistopathological study of an incisional biopsy confirmed metastasic lung adenocarcinoma.

Herein, we report a patient with a rare disease, intrapulmonary schwannoma. The patient was a 61-year-old woman who had a 20 mm × 18 mm nodule, with a clear boundary and homogeneous content, on the central side of S4 in the right lung on chest CT. On PET with 18- fluorodeoxyglucose scanning, 18-fluorodeoxyglucose accumulations with a maximal standardized uptake value of 2.5 and 3.3 were observed in the early and late phases, respectively, suggesting a malignant tumor. A thoracoscopic right middle lobectomy was performed because the tumor was present in the segmental bronchial region of the middle lobe. Intrapulmonary schwannoma accounts for 0.2% of lung tumor cases, and cases involving patients who have undergone preoperative PET with 18- fluorodeoxyglucose scanning have rarely been reported.