However, the majority of reported resections have been with open thoracotomy [4,7–10]. Adhesions were commonly encountered upon entering the thorax and were divided with blunt or sharp dissection, or electrocautery. Fourteen (10%) of patients grew primarily M. abscessus or M. chelonae preoperatively. In Defense of Lady Windermere Syndrome. The Lady Windermere syndrome. The changes are subtle and may be missed. Typical imaging features include right middle lobe and lingula predominant scarring, nodules, bronchiectasis, bronchitis, and bronchiolitis. Chest 101(6):1605–1609, PubMed Article Whether this represented a true genetic difference in susceptibility, and/or differing environmental exposures, or some combination remains unknown at the present time, although it would seem likely that genetics might have had a considerable role. In 1992, two researchers coined the term Lady Windermere syndrome , which comes from a character in an Oscar Wilde Victorian-era play. This case illustrates the classic chest radiograph and computed tomography findings of The Lady Windermere Syndrome. It is also seen in children 1. A thoracoscopic approach for patients with Lady Windermere syndrome can be accomplished with minimal morbidity and mortality. Lady Windermere syndrome is a type of mycobacterial lung infection caused by Mycobacterium avium and M. intracellulare (called the “M. Mycobacterium avium-intracellulare infection (MAI) is an atypical mycobacterial infection, i.e. Search for other works by this author on: Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome, An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases, Resection of the right middle lobe and lingula for mycobacterial infection, Anatomic lung resection for nontuberculous mycobacterial disease, Clinical and microbiologic outcomes in patients receiving treatment for, Current strategy for surgical management of bronchiectasis, Surgical treatment in bronchiectasis: analysis of 166 patients, Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis, Surgical treatment of bronchiectasis: a retrospective analysis of 790 patients, Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database, Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients, Is video-assisted thoracic surgery lobectomy better? The syndrome, which was named after a fussy character in Oscar Wild’s Lady Windermere’s Fan, is frequently found in elderly women with scoliosis, pectus excavatum, and mitral valve prolapse, without severe cardiopulmonary disease or significant smoking history . The authors named it Lady Windermere syndrome, after a fastidious character in the Oscar Wilde play “Lady Windermere’s Fan.” They postulated that the women who developed this infection were too “proper” to cough when they got this bronchitis and so ended up with a … The spectrum of damage to the lung ranges from focal bronchiectasis or cavitary disease, to a completely destroyed lung [2,4,7–11]. Hemoptysis, chest pain, and dyspnea are also reported 1. In many cases, satisfactory completion of appropriate antibiotic treatment dictated the timing of surgical resection. Cavitation was especially interesting because that traditionally had not been part of the Lady Windermere syndrome. Our review was retrospective in nature, and thus susceptible to flaws typical of such an approach. A chest radiograph showed widespread bronchiectasis bilaterally, but no consolidative opacities, pleural effusions, pulmonary edema, or pneumothoraces (Fig. Reich and Johnson  first used the term “Lady Windermere syndrome” in 1992.They described 6 elderly women who were immunocompetent, had no significant smoking history or underlying pulmonary disease, and developed Mycobacterium avium complex (MAC) pulmonary infection limited to the right middle lobe or lingula. Lady Windermere syndrome refers to a subset of patients with NTM lung disease and isolated right middle lobe and lingular bronchiectasis. In one patient, completion of the bronchoplasty required an extension of the utility incision. This complex is composed of 3 species of mycobacterium. Objective: Lady Windermere syndrome is a well-known but poorly understood female predominant phenotype of isolated right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial (NTM) infection. The patient was initially prescribed ceftazidime and levofloxacin with transition to clarithromycin, rifampin, and ethambutol for 1 year, with complete resolution of her symptoms. Dubbed “Lady Windermere Syndrome”, the phenotype includes low body mass index (BMI), tall stature, and higher than normal prevalence of scoliosis, pectus excavatum and mitral valve prolapse. (2019, February 27). Subsequent diagnosis showed she had Lady Windermere syndrome, a lung infection related to bronchiectasis (BE), a chronic airway disease. Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. This study demonstrates that a thoracoscopic approach to pulmonary resection in patients with pulmonary NTM disease and bronchiectasis is both feasible and safe with minimal mortality and morbidity. Mycobacterium avium Complex Medicine & Life Sciences. 7. Babies and children are larger than normal usually until age 8, when growth slows down, resulting in an average height in adults. Eight patients who converted subsequently developed recurrent positive sputum cultures, representing either relapse or reinfection. Internal and Emergency Medicine 7 thanks. Patients suffer high rates of antibiotic-related side effects or intolerance, and relapse or reinfection rates remain around 20–44%, even with the addition of macrolide therapy [5,6]. MAC is the most commonly found form of non-tuberculosis mycobacteria, and it is believed that MAC can be transmitted through inhalation (respiratory tract) or ingestion (into the gastrointestinal tract).