Right middle lobe syndrome

Right middle lobe syndrome refers to chronic right middle lobe collapse, without an obstructing lesion, and usually with associated bronchiectasis

Right middle lobe syndrome is usually encountered in older adults, with a predilection for women (see Lady Windermere syndrome). It is also seen in children 1

In most cases, patients are asymptomatic. Otherwise, a chronic cough is the most common symptom. Haemoptysis, chest pain and dyspnoea are also reported 1.  

The underlying aetiology of right middle lobe syndrome remains poorly understood, but poor collateral ventilation, a relatively narrow ostium and infection/inflammation are all thought to play a role 3. The histological process identified in such cases include 1

  • chronic bronchitis or bronchiolitis
  • bronchiectasis
  • lymphoid hyperplasia
  • granulomatous inflammation +/- MAC infection (classic but found only in a minority of cases)
  • organising pneumonia

The radiographic features of right middle lobe syndrome are the combination of:

  1. right middle lobe collapse
  2. bronchiectasis

Importantly an obstructing bronchial lesion is usually not found. 

Share article

Article information

rID: 15352
Systems: Chest, Paediatrics
Section: Syndromes
Synonyms or Alternate Spellings:
  • Middle lobe syndrome

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Updating… Please wait.

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.