Right Middle Lobe Collapse (Mucous
    Plug)
    The chest X ray is showing a triangular
    opacity of the right middle lobe
    overshadowing the right heart border  which
    means that the lobe involved is adjacent to
    the heart border (Right lower lobe opacities
    will sillhouette the diaphragm).
    Volume loss and mediastinal shift is seen on
    the right side.
Click for larger image
    * A right lateral view was ordered and
    confirmed the findings of the PA view.
    The middle lobe wedge shaped atelectasis
    was seen and the lower lobes were
    adequately areated with free costophrenic
    angles and un-obscured diaphragmatic
    domes.
Click for larger image
    * Not to our surprise we found an almost
    normal Chest X ray after 12 hours of proper
    hydration, intensive chest physiotherapy,
    bronchodilator inhalation, and breathing
    exercises.
    and we were left with right hilar shadowing
    and minor bronchiectatic rings seen in
    chronic asthmatics.
Click for larger image
    Mucous plugs are not uncommon specially in the pediatric age group with small
    caliber bronchi.
    They usually occur in a number of pulmonary conditions, including cystic fibrosis,
    bronchiectasis, allergic bronchopulmonary aspergillosis, and bronchial asthma.
    Treatment with antibiotics, corticosteroids, hydration, and chest physiotherapy
    often produces improvement.
    When these measures fail and radiographic findings indicate the presence of a
    central plug, bronchoscopy is required to achieve lung expansion.
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