Preliminary Diagnosis: Right Middle Lobe Syndrome
I. What imaging technique is first-line for this diagnosis?
Chest x-ray. PA, and lateral.
II. Describe the advantages and disadvantages of this technique for diagnosing right middle lobe syndrome.
Advantages
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Highly portable and inexpensive imaging modality.
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Exposes patients to negligible ionizing radiation.
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Highly sensitive in evaluating for right middle lobe syndrome.
Disadvantages
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Less adept than other imaging modalities in detecting any other underlying parenchymal or pleural process or any secondary complications.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.
IV. What alternative imaging techniques are available?
CT with contrast of the chest.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing right middle lobe syndrome.
Advantages
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Gold standard for evaluating for evidence of right middle lobe atelectasis.
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Highly sensitive and specific in diagnosing any underlying primary pulmonary process or secondary complications.
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May help guide treatment.
Disadvantages
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Better adept in detecting and detailing the etiology for right middle lobe syndrome.
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Exposes patients to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
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May be contraindicated in pregnant patients.
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Relative contraindication in patients with renal failure.
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Relative contraindication in patients with contrast allergy.
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