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Case of the Week 363

What's the most likely diagnosis?

  • 59 year-old female with persistent cough

PA and lateral chest radiographs

  1. Aortic dissection
  2. Pulmonary arterial hypertension
  3. Large bowel obstruction
  4. Compression fracture
  5. Right middle lobe syndrome

Additional Image - PA and lateral chest radiographs-3 months later


Additional Image


PA and lateral chest-3 months after first




5. Right Middle Lobe Syndrome



More (Click Discussion Tab)

Right Middle Lobe Syndrome

General Considerations

  • Definition varies
  • Usually refers to any cause of recurrent or persistent atelectasis of the right middle lobe
  • Occurs at all ages but most common at two peaks: in children and over 50
    • Reportedly more common in women than men
  • Originally thought to be due only to bronchial obstruction, but it is more often present with non-obstructive lesions
    • Some believe the right middle lobe is more often involved because of its isolation and poor collateral flow from the upper and lower lobes

    More ...


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