Chronic right middle lobe atelectasis in ambulatory children

Background: Intrinsic obstruction and extrinsic compression of the airway are the main causes of pulmonary atelectasis. The differential diagnoses of right middle lobe atelectasis (MLA) in children are lengthy, and practicing pediatricians usually are frustrated by the diagnostic possibilities in the clinic. Objective: The aim of our study is to present the experience of a children facility with chronic MLA in ambulatory children and guide a pragmatic approach. Materials and Methods: Retrospective chart analysis was performed by a computer search for discharge diagnosis of right MLA or MLA between January 2006 and December 2017 in a pediatric department in Northern Taiwan. Demographic data, underlying diseases, clinical symptoms, radiographic features, and course of treatment were collected and analyzed by descriptive statistics. Results: A total of 30 pediatric patients with chronic MLA were recruited in this study. Isolated MLA was identified in four (13.3%) patients. The remaining 26 patients had associated atelectasis or bronchiectasis in other parts of the lung. The most common causes of chronic MLA identified in our patients were postinfectious bronchiectasis (40%) and immunodeficiency (23.3%). Asthma was an uncommon cause of MLA in this study. Conclusions: Tumors, tuberculosis, retained foreign body, and asthma were all uncommon in the children identified with MLA. While chronic cough was common in the children studied, most were associated with bronchiectasis in other pulmonary segments. When faced with evidence of right MLA, one should consider a chronic suppurative lung disease with or without bronchiectasis, either postinfectious or related with recurrent aspiration.