Chronic atelectasis
(middle lobe syndrome, Mittellappensyndrom)

General information:

• Missing lung expansion over a period of at least 2-3 weeks due to bronchial stenosis (slit fashioned bronchi, malformation of the bronchial wall, compression from outside by enlarged lymph nodes or vascular anomalies) or intraluminal bronchial obstruction (foreign body).

Symptoms:

• Asymptomatic.
  
• Recurrent signs of pulmonary infections.
  
• Chronic cough.

Diagnostic workout:

• Thoracic X-ray or CT scan.
  
• Bronchoscopy.
  
• Ventilatory and perfusion scintigraphy.
  

Indication for operation:

• No improvement after intensive conservative treatment over a period of 8 weeks.

Treatment/Operation:

• Resection, e.g. middle lobe lobectomy.

Postoperative management:

• Chest tubes may be removed if the lung is fully expanded and drainage volumes decrease below 20 to 50cc during a 24 hour period.
  

Prognosis:

• Good.