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August 29, 1966

Right Middle Lobe Syndrome in Children

JAMA. 1966;197(9):732. doi:10.1001/jama.1966.03110090096035

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To the Editor:—  In a recent article, "Right Middle Lobe Syndrome in Children" (197:8, 1966), reference was made to the value of bronchograms in children "whose posteroanterior and lateral x-rays showed... equivocal changes such as blurred heart border, increased bronchovascular markings etc...." No mention was made of films taken in lordotic view which, in my opinion, has proved, both in adults and in children, useful in recognizing or evaluating parenchymal infiltrative pathology in the middle lobe of the right lung. This holds specifically in cases in which the ambiguous or inconclusive signs in the right lower lung field don't allow a more distinct diagnostic approach. In these cases a film taken in lordosis frequently produces a typical wedgeshaped density in the basal central zone of the right lower lung field representing a parenchymal involvement of the middle lobe. Thus the lordotic view should be part of the x-ray examination