Index
The collapse or closure of the lung results in reduced or absent gas exchange. It can affect part or all of a lung.
It is usually one-sided. It is a condition in which the alveoli are deflated at little or no volume, unlike the pulmonary consolidation, in which they fill with fluid.
It is often called a collapsed lung, although it may also refer to pneumothorax.
It is a prevalent finding on chest x-rays and other radiological studies and may be caused by normal exhalation or various medical conditions.
Although it is often described as a collapse of lung tissue, atelectasis is not synonymous with a pneumothorax, a more specific condition that presents atelectasis.
Acute atelectasis can occur as a postoperative complication or surfactant deficiency. In preterm infants, this leads to infant respiratory distress syndrome.
The term uses combined forms of atel + ectasia, from Greek: ἀτελής, “incomplete” + ἔκτασις, “extension.”
Signs and symptoms of atelectasis
It may not have signs and symptoms or may include:
- Cough, but not prominent.
- Chest pain (not joint)
- Difficulty breathing (fast and superficial).
- Low oxygen saturation.
- Pleural effusion (transduced type).
- Cyanosis (late sign).
- Incrise of cardiac frecuency.
It is a common misconception that atelectasis causes fever. A study of 100 postoperative patients followed by serial chest radiographs and temperature measurements showed that fever decreased as the incidence of atelectasis increased.
A recent review article summarizing available published evidence on the association between atelectasis and postoperative fever concluded that no clinical evidence supports this doctrine.
Causes
Postoperative atelectasis is the most common cause, characterized by splinting and restricted breathing after abdominal surgery. Another common cause is pulmonary tuberculosis. Smokers and the elderly are also at greater risk.
Outside of this context, atelectasis involves some blockage of a bronchiole or bronchus, which can be inside the respiratory tract (foreign body, mucus plug), the wall (tumor, usually squamous cell carcinoma), or compressed from the outside (tumor, lymph node, tubercle).
Another cause is the poor diffusion of the surfactant during inspiration, which makes the surface tension maximum, which tends to collapse the smaller alveoli.
Atelectasis can also occur during suction since, together with sputum, the air is removed from the lungs.
There are several types of atelectasis according to their underlying mechanisms or the distribution of alveolar collapse; resorption, compression, microatelectasis, and atelectasis by contraction.
Relaxation atelectasis (also called passive atelectasis) occurs when a pleural effusion or pneumothorax interrupts contact between the parietal and the visceral pleura.
Mechanisms of pulmonary atelectasis
Atelectasis is one of the most frequent abnormalities in chest radiology and remains a daily diagnostic challenge.
Occasionally, atelectasis can be overlooked, mainly when pulmonary opacification is minimal or non-existent, and at other times it can be interpreted as another form of intrathoracic pathology, particularly pneumonia.
The direct signs of atelectasis are crowded pulmonary vessels, crowded air bronchograms, and displacement of interlobar fissures.
Indirect signs of atelectasis are pulmonary opacification, the diaphragm elevation, displacement of the trachea, heart, and mediastinum, removal of the hilus, compensatory hyper expansion of the surrounding lung, approximation of the ribs, and changing granulomas.
The radiograph should be interpreted as atelectasis whenever there are signs of volume loss on a chest x-ray.
By understanding the various mechanisms that lead to atelectasis and considering the underlying conditions, the radiologist must develop a good list of the possible causes of atelectasis.
The diagnosis of pneumonia atelectasis should be based on signs and symptoms of pneumonia and the identification of pathogenic bacteria in the sputum, tracheal aspirates, protected bronchoalveolar lavage, or bronchial brush specimens rather than the radiographic title of atelectasis only clinical.
Diagnosis
Clinically significant atelectasis is usually visible on the chest radiograph; the findings may include pulmonary opacification and loss of lung volume. PostsurgicalPostsurgical atelectasis will be bibasal type.
Thoracic computed tomography or bronchoscopy may be necessary if the cause of atelectasis is not clinically apparent.
Direct signs of atelectasis include:
- Displacement of interlobar fissures and mobile structures within the thorax.
- Overinflation of the unaffected ipsilateral lobe or contralateral lung.
- Opacification of the collapsed lobe.
Classification
Atelectasis can be an acute or chronic condition. In acute atelectasis, the lung recently collapsed and is mainly notable only for lack of air.
In chronic atelectasis, the affected area is often characterized by a complex mixture of shortness of breath, infection, widening of the bronchi (bronchiectasis), destruction, and scarring (fibrosis).
Abstraction atelectasis (resorption)
Absorption atelectasis is caused by reabsorption of the alveolar air distal to the obstructive airway lesions.
The atmosphere is composed of 78% nitrogen and 21% oxygen. Since oxygen is exchanged in the alveolar-capillary membrane, nitrogen is a significant component of the alveolar inflation state.
Suppose a large volume of nitrogen is replaced in the lungs with oxygen. In that case, the oxygen can be subsequently absorbed into the blood, reducing the importance of the alveoli, which produces a form of alveolar collapse known as absorption atelectasis.
Compression (relaxation) atelectasis
It is usually associated with the accumulation of blood, fluid, or air within the pleural cavity, which mechanically collapses the lung.
This is a frequent cause of pleural effusion caused by congestive heart failure (CHF). Air leakage into the pleural cavity (pneumothorax) also leads to compression atelectasis.
Both passive atelectasis and compression atelectasis are caused by a secondary effect of compression of the normal lung by a large lung lesion.
In passive atelectasis, the lesion is intrapleural (such as a large pleural effusion or pneumothorax), but the problem is an intrapulmonary mass occupied by the primary space in compressed atelectasis.
Atelectasis may develop due to retraction of the adjacent lung.
Cicatrization (contraction) atelectasis
It occurs when local or generalized fibrotic changes in the lung or pleura hinder expansion and increase elastic recoil during expiration. Causes include granulomatous disease, necrotizing pneumonia, and radiation fibrosis.
Chronic atelectasis
Chronic atelectasis can take two forms: middle lobe syndrome or rounded atelectasis.
Right middle lobe syndrome
In the right middle lobe syndrome, the middle lobe of the proper lung contracts, usually due to pressure on the enlarged lymph node bronchi and occasionally a tumor.
The blocked and contracted lung can develop pneumonia that does not resolve entirely and produces chronic inflammation, scarring, and bronchiectasis.
Rounded atelectasis
In rounded atelectasis (collapsed lung or Blesovsky’s syndrome ), an external portion of the lung slowly collapses due to scarring and contraction of the membrane layers covering the lungs (pleura), which would show visceral pleural thickening and entrapment of the lung. lung tissue
This produces a rounded appearance on X-rays that doctors may mistake for a tumor.
Rounded atelectasis is usually a complication of the pleura induced by asbestos but may also be a consequence of other types of chronic scarring and thickening of the pleura.
Adherelectasia adhesive
Adhesive atelectasis is seen in premature babies who can not breathe spontaneously. In some babies, after a few days of developing breathing difficulties, their lungs show areas in which the alveoli, or air sacs, do not expand with air.
These babies usually suffer from a disorder called respiratory distress syndrome, in which the surface tension within the alveolus is altered so that the alveoli collapse perpetually.
This is usually caused by a failure to develop active surface material (surfactant) in the lungs. Treatment for babies with this syndrome includes replacement therapy with surfactant.
Obstructive atelectasis
Obstructive atelectasis can be caused by foreign objects lodged in one of the primary bronchial tubes, which causes the air trapped in the alveoli to be slowly absorbed by the blood.
It can also occur as a complication of abdominal surgery. The air passages in the lungs normally secrete a mucous substance to trap dust, soot, and bacterial cells, which often enter with inhaled air.
When a person undergoes surgery, the anesthetic stimulates an increase in bronchial secretions. If these secretions become too abundant, they can be expelled from the bronchi when coughing or exhaling refreshing air.
After abdominal surgery, breathing usually becomes more superficial due to the acute pain induced by respiratory movements, and the muscles under the lungs may weaken.
Mucous plugs can cause atelectasis. Other causes of obstruction include tumors or infections.
Atelectasis dependent on gravity
Gravity-dependent atelectasis results from alterations dependent on gravity in the alveolar volume.
It is a relatively benign form of atelectasis that usually does not require treatment. It is caused by small areas of your lung that can not fully expand when lying down.
The small portion of the lung that collapses under the influence of gravity usually expands on its own once you get up or change position. It is usually detected during a chest CT scan.
Minor dependent atelectasis
Minimal dependent atelectasis is a problem in which only a tiny portion of the lung collapses and, therefore, is not as severe as regular atelectasis. This condition usually affects the alveoli in the lower part of the lungs.
While anyone can suffer from minimal atelectasis, this problem is more likely to occur in elderly or bedridden people.
Staying in the same position for long periods often leads to poor ventilation of the lungs.
Patients on bed rest after surgery may also develop atelectasis or atelectasis dependent if they are not made to move approximately every hour or so.
The risks of this condition are also much higher in severely overweight people since their lungs do not expand properly when they remain in one position for a long time.
The symptoms are usually not very serious because minimal atelectasis affects only a tiny part of the lungs.
Most patients only become aware of the condition when they undergo an imaging test to rule out the possibility of another medical problem.
If you experience these symptoms, your doctor may do a physical exam before you are asked to have tests like an x-ray, an ultrasound, or a chest CT scan.
Although minimal dependent atelectasis is not a severe condition, it should be reviewed and treated by a doctor without delay.
Mild atelectasis dependent
This condition is called mild dependent atelectasis if the lungs are partially affected. Mild dependence often does not affect the quality of life. If the disease is mild, although the lungs are damaged, it does not affect the quality of life.
When the condition is not so severe, you may not even feel the symptoms. If atelectasis is severe, organs tend to be deprived of oxygen and may cause additional complications.
Mild subsegmental atelectasis is a type of atelectasis in which the left lobe of the lungs is affected. In this type, linear fissures appear in the lung and appear below the chest radiographs.
The diagnosis of atelectasis depends on the cause. In adults, it is usually temporary and resolves without treatment as soon as the condition that triggers atelectasis is recovered.
If the lungs remain deflated for a more extended period, it can be difficult for the lungs to clear the mucus. This delay could cause infections such as pneumonia.
Atelectasis in children or children can be fatal, significantly if they affect a large part of the lungs. People with lung diseases such as emphysema can easily be simulated with atelectasis.
Since atelectasis is usually a mild type of this condition, the symptoms are generally not present.
When present, symptoms usually occur while lying down and may include shortness of breath, chest pain, and coughing.
Atelectasis lobar
Lobar atelectasis is a common problem caused by various mechanisms that include atelectasis due to resorption due to airway obstruction, passive atelectasis due to hypoventilation, compressive atelectasis due to abdominal distention, and adhesive atelectasis due to increased surface tension.
However, studies based on evidence about the management of lobar atelectasis are lacking. The examination of air bronchograms on a chest radiograph may help determine if the proximal or distal airway obstruction is involved.
Chest physiotherapy, nebulized DNase, and possibly fiberoptic bronchoscopy may be helpful in patients with mucosal airway obstruction.
Positive end-expiratory pressure can be a valuable adjunct to passive and adhesive atelectasis treatment.
Atelectasis segmentaria
Segmental atelectasis refers to the collapse of one or several segments of a pulmonary lobe. It is a morphological subtype of pulmonary atelectasis. It is best seen on computed tomography. Its radiographic appearance can range from a thin linear to a wedge-shaped opacity and then does not rest on an interlobar fissure.
Atelectasia subsegmental
It affects only the part of a lung distal to an occluded segmental bronchus.
Subsegmental atelectasis is atherosclerosis in which the lung volume decreases due to obstruction in the subsegmental bronchus or a small bronchus.
Subsegmental atelectasis often occurs due to a tiny foreign body in the bronchus. It is more common in children, where small foods such as grains and peanuts can lodge in the bronchi during ingestion.
Subsegmental atelectasis is usually mild and produces no symptoms that may cause discomfort to the patient. However, it can cause symptoms such as coughing and shortness of breath in some cases. The cough is not productive and pirates. A minimal amount of mucus is expelled.
Flat atelectasis
Plate-like atelectasis is also known as dielectric or subsegmental atelectasis. The obstruction of the small bronchi produces atelectasis of the plaque. Hypoventilation, pulmonary embolism, and lower respiratory tract infection are common factors that cause the obstruction.
Atelectasis occurs if the lungs can not fully expand and fill the air. This can be caused by factors that prevent deep breathing, coughing, and airway blockage. The obstruction of the bronchus is the leading cause of atelectasis. It is common after surgery.
Linear or discoid atelectasis
Linear atelectasis occurs when a portion of the lungs away from the bronchus has collapsed. And the collapsed part is linear because it is all together.
Discoid atelectasis is one of those types of atelectasis. Discoid atelectasis refers to a small area or small segment of the lungs affected by the condition.
On a chest x-ray, discoid atelectasis will appear as a disc or shadow similar to a plaque in the lungs.
This disc can be linear or horizontal in its position. Discolecular or platelet atelectasis is diagnosed and treated in a manner very similar to other types of atelectasis.
As with most other types of atelectasis, the symptoms of discoid atelectasis are often confused with other diseases.
Symptoms such as breathing difficulties, chest pain, and cough are general enough to make the diagnosis of the disease problematic.
Only with a chest x-ray or a chest CT scan, a doctor confirms your atelectasis diagnosis.
When the area of collapse is small, there can often be no symptoms or signs, and the condition can be resolved over time.
However, in severe cases, the symptoms can affect a person’s breathing and can be life-threatening if not treated in time.
Treatment
The treatment is aimed at correcting the underlying cause. PostsurgicalPostsurgical atelectasis is treated by physiotherapy, focusing on deep breathing and stimulating cough.
An incentive spirometer is often used as part of breathing exercises. Walking is also highly recommended to improve lung inflation.
People with chest deformities or neurological conditions that cause shallow breathing for prolonged periods can benefit from mechanical devices that help their breathing.
One method is continuous positive pressure in the airways, which supplies air or oxygen under pressure through a nasal or facial mask to help ensure that the alveoli do not collapse, even at the end of breathing.
This is useful since partially inflated alveoli can expand more quickly than collapsed alveoli. Sometimes additional respiratory support is needed with a mechanical ventilator.
The primary treatment for acute massive atelectasis is correcting the underlying cause. A blockage that can not be eliminated by coughing or suctioning the airways can often be removed by bronchoscopy.
Antibiotics are given for an infection. Chronic atelectasis is often treated with antibiotics because the disease is almost inevitable.
In some instances, the affected part of the lung can be surgically removed when recurrent or chronic infections become disabling or bleeding is essential.
If a tumor blocks the airways and relieves the obstruction, surgery, radiation therapy, chemotherapy, or laser therapy can prevent the progression of atelectasis and develop recurrent obstructive pneumonia.
