Obstructive atelectasis is the commonest type of lung collapse resulting from a blockade at the level of the small or the large airways.
Presentation
Patients of obstructive atelectasis are usually asymptomatic, with the development of clinical features dependent on the location and size of the affected pulmonary regions, the nature of occlusion and the presence of concomitant infection.
Hypoxemia is primarily responsible for the majority of symptoms seen in patients with obstructive collapse. Rapid blockade of the bronchi produces sudden dyspnea, cyanosis or even respiratory failure. A slow, less severe occlusion may be completely asymptomatic.
Pneumonia is also commonly seen in patients of atelectasis, presenting with symptoms such as cough with expectoration, fever, chest pain and breathlessness. Pleuritic pain may also originate from the underlying etiology responsible for lung collapse.
Overt clinical signs are often undetectable in cases of atelectasis. Large sections of lung collapse may lead to areas of dullness and decreased chest expansion. Breath sounds may also be reduced in such regions. Hypotension, tachycardia, and shock may also be seen in a few cases. Controversy exists regarding the association of atelectasis with early postoperative fever [1].
Some patients may suffer from the middle lobe syndrome, which presents with a dry, severe, hacking cough due to a blockage of the right middle/lower lobe bronchi [2] [3].
Entire Body System
- Collapse
Obstructive atelectasis is the commonest type of lung collapse resulting from a blockade at the level of the small or the large airways. [symptoma.com]
See also: pulmonary collapse. [medical-dictionary.thefreedictionary.com]
There is partial collapse of the right lung in a patient with large right pneumothorax. Contact Category: Sundries [aibolita.com]
Hence, this type of collapse is frequently seen with co-existing consolidation. [radiopaedia.org]
Loss of lung volume - collapse of part of lung -Caused by a blockage of the air passages or by pressure on the outside of the lung -Classification: Obstructive or Compression Loss of lung volume - collapse of part of lung Loss of lung volume - collapse [quizlet.com]
- Fatigue
In some cases, the patient will develop a low-grade fever in response to fatigue. What Causes Atelectasis There are a variety of ways that atelectasis can develop. [lunginstitute.com]
Severe Symptoms Tightness of the chest Skin color turning blue due to lack of oxygen Near fainting and lightheadedness Fatigue Rapid heart rate Treatment of Lungs Collapse The main objective behind treatment of lungs collapse is to expand it again. [findatopdoc.com]
The respiratory muscles of patients with COPD are chronically overworked and fatigued, whereas the extremity muscles tend to be underworked and atrophied. [aafp.org]
Respiratoric
- Cough
Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%). [ncbi.nlm.nih.gov]
This usually results when there is bleeding taking place into the lungs that cannot be coughed up. On many occasions, there are no apparent symptoms of atelectasis. [home-remedies-for-you.com]
Pneumonia is also commonly seen in patients of atelectasis, presenting with symptoms such as cough with expectoration, fever, chest pain and breathlessness. [symptoma.com]
You cough up blood continuously or more than 3 teaspoons. When should I seek immediate care? Your symptoms return. You have a fever. You cough up blood. When should I contact my healthcare provider? You are coughing up a large amount of mucus. [drugs.com]
Clinical findings Low-grade fever, dry cough, chest pain, shortness of breath. [medical-dictionary.thefreedictionary.com]
- Dyspnea
Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%). [ncbi.nlm.nih.gov]
Depending upon it there may be sudden onset of dyspnea first followed by hypoxia, hypotension and cyanosis and death may ensue. If the area affected is very small then there may be just dyspnea and a dry cough with mild chest pain. [differencebetween.net]
Patients with more advanced disease may have pursed lip breathing or postures that relieve dyspnea (e.g., leaning forward against outstretched palms). [aafp.org]
Rapid blockade of the bronchi produces sudden dyspnea, cyanosis or even respiratory failure. A slow, less severe occlusion may be completely asymptomatic. [symptoma.com]
Rapid bronchial occlusion with a large area of lung collapse causes pain on the affected side, sudden onset of dyspnea, and cyanosis. Hypotension, tachycardia, fever, and shock may also occur. [slideshare.net]
- Sputum
The incidence of dyspnea, cough, and sputum production before starting treatment and 1, 3, and 6 months later was determined. [ncbi.nlm.nih.gov]
Geriatrics—Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Via Alvaro del Portillo 200, Rome 00128, Italy; s.scarlata{at}unicampus.it Statistics from Altmetric.com Lung Atelectasis A 78-year-old man presented with cough, sputum [pmj.bmj.com]
Predominantly fixed airflow obstruction Bronchiectasis frequent in upper lobes Sweat chloride test (diagnostic), Bacterial sputum culture CLINICAL HISTORY Patients with COPD typically present with cough, sputum production, and dyspnea on exertion. [aafp.org]
Sputum test is important as it reveals the organism causing infection and accordingly antibiotics can be started. [differencebetween.net]
- Dry Cough
Clinical findings Low-grade fever, dry cough, chest pain, shortness of breath. [medical-dictionary.thefreedictionary.com]
If the area affected is very small then there may be just dyspnea and a dry cough with mild chest pain. Hence, both the diseases are easily distinguishable based on their causes and the symptoms. [differencebetween.net]
せき(咳) croupクループ cryptogenic特発性 cuffed tracheal tubeカフ付き気管チューブ d deformity奇形 desensitization脱感作 diaphragm 横隔膜 difficulty in breathing呼吸困難 diffuse びまん性の diffuse panbronchiolitis びまん性汎細気管支炎 diffusion拡散 discontinuous sound[s]断続[性ラ]音 dry cough乾性咳[嗽]、痰を伴わないせき [tokyo-med.ac.jp]
- Painful Cough
Acceleration atelectasis can cause symptoms like chest pain, coughing, and dyspnea. E. [medicowesome.com]
Causes of non-obstructive atelectasis: Trauma: Pain resulting from injury to the chest area can make it difficult to inhale and cough. [innerbody.com]
Workup
Hypoxemia resulting from obstructive atelectasis may be easily confirmed by an arterial blood gas analysis. A low partial pressure of oxygen in the arteries (PaO2) is often accompanied by a normal arterial carbon dioxide level (PaCO2) due to the compensatory increase in ventilation seen in such patients.
Imaging studies such as chest X-rays and computed tomography (CT) scans produce conclusive evidence of lung collapse [4] [5] [6] [7]. Opacification of the affected lobes along with blurring/ displacement of the lung fissures are some of the direct signs seen in these studies. Some of the other signs that may indicate an atelectasis include: a shift of the mediastinal and hilar contents towards the side of the collapse, decreased rib spacing on the affected side, elevation of the ipsilateral dome of the diaphragm, increased translucency of the other normal lobes and loss of normal borders of the heart/ diaphragm (silhouette sign).
Atelectasis of an entire lung is characterized by whitening (opacification) of the hemithorax accompanied by some of the indirect signs of lung collapse listed above. Atelectasis resulting from thickening of the pleura is termed as rounded atelectasis [8] [9]. This segmental anomaly is usually seen on imaging as a subpleural mass, with bronchovascular markings radiating out to the lung hilum [10]. Pleural plaques are also commonly observed in such cases. Rounded atelectasis is commonly seen in the middle/ lower lobes.
Another investigation with therapeutic potential is flexible fibreoptic bronchoscopy that may help in determining the etiology of obstruction. Bronchoscopy may also afford clinical relief by clearing the respiratory tract of secretions. Obstructions distal to the subsegmental bronchi are however not easily visualized by this procedure.
Biopsies obtained from obstructive masses encountered during bronchoscopy must be evaluated for the histologic presence of infection, malignancy or any other possible etiologies of atelectasis.
X-Ray
- Mediastinal Shift
shift ipsilateral tracheal deviation ipsilateral shift of the heart [radiopaedia.org]
Repeat chest radiograph revealed white out of the right hemi-thorax with tracheal and mediastinal shift to right [Figure 2] a. [indianjcancer.com]
This effect can lead to an elevated diaphragm and mediastinal shift to the affected side. Treatment depends on the underlying cause. Complications of atelectasis include pneumonia or, depending on the extent of disease, respiratory failure. [amboss.com]
Laboratory testing showed leukocytosis (12.5 × 10 9 ) with left shift (75% neutrophils). Chest X-ray revealed atelectasis of the right upper lobe (RUL) with ipsilateral mediastinal shift ( Fig. 1 ). X-ray on admission was normal. [archbronconeumol.org]
Treatment
The incidence of dyspnea, cough, and sputum production before starting treatment and 1, 3, and 6 months later was determined. [ncbi.nlm.nih.gov]
Unique Challenge, Think About, and Emergency Treatment features help in applying the material to real-life situations. [books.google.de]
These data suggest that NIMV may be useful in the treatment of atelectasis is some critical patients. [archbronconeumol.org]
The treatment of atelectasis will vary depending on the cause. If a small area of the lung is affected, a patient may not need any treatment. [pccfl.com]
Prognosis
Read More: Clean Air for a Better Respiratory System Prognosis of Atelectasis The outcome of atelectasis usually depends on the treatment of the underlying cause. [steadyhealth.com]
If atelectasis is a result of surgery, other postoperative conditions and/or complications affect the prognosis. Prevention When recovering from surgery, frequent repositioning in bed along with coughing and deep breathing are important. [medical-dictionary.thefreedictionary.com]
[…] acetylcysteine [Mucomyst]) • Recombinant human DNase (dornase alpha) in patients with cystic fibrosis • Bronchodilator therapy in selected patients CHRONIC Rx Chest physiotherapy, humidification of inspired air, frequent nasotracheal suctioning DISPOSITION Prognosis [encyclopedia.lubopitko-bg.com]
Taking these steps can ensure your symptoms do not worsen and give you the most favorable future prognosis: » Keep a daily journal log of your symptoms, including any breathing changes. » Take the help of PEP devices to strengthen breath and lung function [thehealthyapron.com]
Etiology
Pleuritic pain may also originate from the underlying etiology responsible for lung collapse. Overt clinical signs are often undetectable in cases of atelectasis. [symptoma.com]
[…] atelectasis of an entire lung ("collapsed lung") can result from complete obstruction of the right or left main bronchus passive (relaxation) atelectasis occurs when contact between the parietal and visceral pleura is disrupted the two most common specific etiologies [radiopaedia.org]
Etiology Obstructive atelectasis (most common): airway obstruction (e.g., by a foreign body, mucus plug, malignanc y) → nonventilated alveoli → reabsorption of gas in the poststenotic space → lung collapse Nonobstructive atelectasis Compression atelectasis [amboss.com]
PHYSICAL FINDINGS & CLINICAL PRESENTATION • Decreased or absent breath sounds • Abnormal chest percussion • Cough, dyspnea, decreased vocal fremitus and vocal resonance • Diminished chest expansion, tachypnea, tachycardia ETIOLOGY • Mechanical ventilation [encyclopedia.lubopitko-bg.com]
Epidemiology
Epidemiology Definition : collapse of aerated lung Etymology: Greek roots ateles and ektasis = incomplete expansion Etiology Obstructive Atelectasis (Due to Airway Obstruction) (see Obstructive Lung Disease, [[Obstructive Lung Disease]]) Tracheobronchial [mdnxs.com]
Introduction Clinical definition atelectasis is decreased expansion or loss of volume affecting the lungs from the Greek words ateles and ektasis or “incomplete expansion” Epidemiology incidence very common demographics more common in older patients risk [medbullets.com]
References: [2] [6] [7] Differential diagnoses Pulmonary sequestration Definition : rare congenital malformation in which a mass of nonfunctional pulmonary tissue has no connection to the bronchial tree and does not participate in gaseous exchange Epidemiology [amboss.com]
EPIDEMIOLOGY & DEMOGRAPHICS • Occurs frequently in patients receiving mechanical ventilation with higher Fio 2. • Dependent regions of the lung are more prone to atelectasis: they are partially compressed, they are not as well ventilated, and there is [encyclopedia.lubopitko-bg.com]
Epidemiology Mean age is 60 years, but all ages are susceptible. Male = female; no racial or socioeconomic predilection Incidence Rounded atelectasis can be seen in up to 65–70% of asbestos workers. [unboundmedicine.com]
Pathophysiology
Obstructive atelectasis of the lung Simone Scarlata, Isaura Rossi Bartoli, Claudio Pedone, Raffaele Antonelli Incalzi Geriatrics—Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Rome, Italy Correspondence to Dr [pmj.bmj.com]
A concise, easy-to-understand introduction to the fundamentals, Pathophysiology for the Health Professions, 4th Edition helps you learn to identify disease processes and disorders. [books.google.de]
It is a term used to distinguish atelectasis identified on imaging based on the underlying pathophysiology to guide diagnosis. The presentation of patients with atelectasis depends on the underlying cause. [radiopaedia.org]
This post will be on the classification of Atelectasis based on its pathophysiology and a brief overview of its radiology patterns. Let us deal with the radiology aspects first: 1. [medicowesome.com]
Prevention
15% of the country’s States, the average person of 65 years can gross domestic product. expect to live another 15 years in a fairly Tobacco use is the most serious prevent- good health. Persons of 75 or 85 years old able cause of cancer. [books.google.de]
Breathing exercises and the use of breathing devices, such as an incentive spirometer, may also help prevent atelectasis. [medical-dictionary.thefreedictionary.com]
Discussion Atelectasis may be prevented with respiratory physiotherapy, mechanical insufflation–exsufflation devices, or the application of positive airway pressure. Respiratory physiotherapy in hospitalized patients has been largely ignored. [archbronconeumol.org]
Prevention Preventing this condition can only be fully avoided by avoiding application of anesthetic, since most surgical patients experience this condition at least temporarily.( 8 ) Parents can prevent some cases of obstructive-type bibasilar atelectasis [thehealthyapron.com]
Prevention To decrease the risks of atelectasis : Be careful with small objects and prevent providing a possibility for the children to swallow them, Stop smoking, Do deep-breathing exercises, If you need to stay in bed, reposition yourself and make attempts [humanitas.net]
References
- Mavros MN, Velmahos GC, Falagas ME. Atelectasis as a cause of postoperative fever: where is the clinical evidence?. Chest. 2011 Aug;140(2):418-24.
- Graham EA, Burford TH, Mayer JH. Middle lobe syndrome. Postgrad Med. 1948;4:29–34.
- Livingston GL, Holinger LD, Luck SR. Right middle lobe syndrome in children. Int J Pediatr Otorhinolaryngol. 1987;13:11–23.
- Proto AV, Tocino I. Radiographic manifestations of lobar collapse. Semin Roentgenol. 1980 Apr;15(2):117-73.
- Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354:1775–1786.
- Malbouisson LM, Muller JC, Constantin JM, et al. CT Scan ARDS Study Group. Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001;163:1444–1450.
- Hedenstierna G, Tokics L, Strandberg A, Lundquist H, Brismar B. Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand. 1986;30:183–191.
- Stathopoulos GT, Karamessini MT, Sotiriadi AE, Pastromas VG. Rounded atelectasis of the lung. Respir Med. 2005;99(5):615–23.
- Batra P, Brown K, Hayashi K, et al. Rounded atelectasis. J Thorac Imaging. 1996;11(3):187–97.
- Partap VA. The comet tail sign. Radiology. 1999 Nov;213(2):553-4.