Abstract
Bronchoscopy should be actively performed to differentiate pulmonary tuberculosis in patients with lesions in the middle lobe, which are unaccompanied by bronchiectasis or present without obvious lesions in other lobes.
Keywords: bronchoscopy, pulmonary middle lobe, tuberculosis
Bronchoscopy should be actively performed to differentiate pulmonary tuberculosis in patients with lesions in the middle lobe, which are unaccompanied by bronchiectasis or present without obvious lesions in other lobes.
1. CASE PRESENTATION
Although the pulmonary middle lung lobe is a frequent site for Mycobacterium avium complex infection, bronchoscopy should be actively performed to differentiate pulmonary tuberculosis in patients with lesions in the middle lobe, which are unaccompanied by bronchiectasis or present without obvious lesions in other lobes.
A 79‐year‐old man with a history of renal cancer surgery presented with an abnormal shadow on chest radiography, which was performed during a routine checkup. He had no subjective symptoms. Chest computed tomography revealed multiple nodular opacities in the right middle pulmonary lobe (Figure 1). Smears and cultures of sputum for acid‐fast bacilli were negative. Bronchoscopy did not reveal any endobronchial lesions, and Mycobacterium tuberculosis (TB) was isolated from the bronchoalveolar lavage fluid, obtained from the right middle bronchus. The shadow in the middle lobe disappeared by anti‐TB chemotherapy.
FIGURE 1.
Computed tomography revealing multiple nodular opacities in the right middle pulmonary lobe (A‐C). Bronchiectasis is absent, and pulmonary lesions are not seen in other lobes. Arrowhead showing the minor fissure separating right upper and middle lobe
2. DISCUSSION AND CONCLUSION
The pulmonary middle lung lobe is a frequent site for Mycobacterium avium complex (MAC) infection. 1 Middle lobe TB is usually associated with endobronchial TB, which presents as right middle lobe syndrome, and reports of localized pulmonary TB involving the middle lobe only are rare. Bronchiectasis is less common in patients with TB, and the occurrence of small nodules in only a single lobe is more common in patients with TB than that in patients with MAC infection. 2 Our case suggests that bronchoscopy should be actively performed to differentiate between TB and MAC in patients with lesions in the middle lobe, which are unaccompanied by bronchiectasis or present without obvious lesions in other lobes.
CONFLICT OF INTEREST
None.
AUTHOR CONTRIBUTIONS
AO: was responsible for conception, design, drafting, image modification, and finalizing; YT: was responsible for drafting; YM: was responsible for design and image modification; KF: was responsible for conception and finalizing; KS: was responsible for design and finalizing; all authors read and approved the final manuscript.
ETHICAL APPROVAL
Informed consent for publication and related images has been obtained from the patient.
ACKNOWLEDGMENTS
None.
Okazaki A, Takeda Y, Matsuda Y, Fujita K, Shibata K. Multiple nodular opacities only involving the right middle pulmonary lobe: Unusual manifestation of tuberculosis. Clin Case Rep. 2021;9:e04086. 10.1002/ccr3.4086
Funding information
This research was not supported by any specific grant from any funding agency in the public, commercial, or nonprofit sectors. Therefore, no funders were involved in the design of the study, the collection, analysis, and interpretation of the data, the writing of the manuscript, or the decision to submit the manuscript for publication.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of privacy or ethical restrictions.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of privacy or ethical restrictions.