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Obstructive Atelectasis

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].

Crying
  • This may be due to any of a variety of causes, including prematurity (often accompanying hyaline membrane disease ); diminished nervous stimulus to breathing and crying; fetal hypoxia from any cause, including oversedation of the mother during labor and[medical-dictionary.thefreedictionary.com]
Cough
  • Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%).[ncbi.nlm.nih.gov]
  • Pneumonia is also commonly seen in patients of atelectasis, presenting with symptoms such as cough with expectoration, fever, chest pain and breathlessness.[symptoma.com]
  • 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]
  • Clinical findings Low-grade fever, dry cough, chest pain, shortness of breath.[medical-dictionary.thefreedictionary.com]
  • The patient's situation was critical and the possibility of using Cough Assist , a mechanical cough assistant, as alternative treatment was discussed.[archbronconeumol.org]
Dyspnea
  • Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%).[ncbi.nlm.nih.gov]
  • Rapid blockade of the bronchi produces sudden dyspnea, cyanosis or even respiratory failure. A slow, less severe occlusion may be completely asymptomatic.[symptoma.com]
  • Symptoms may include diminished breath sounds or aspiratory crackles, a mediastinal shift toward the side of the collapse, fever, and increasing dyspnea.[medical-dictionary.thefreedictionary.com]
  • Four days after admission, the patient's general status deteriorated, with dyspnea on minimal effort, worsening to dyspnea at rest accompanied by significant work-of-breathing and progressively diminishing level of consciousness.[archbronconeumol.org]
  • […] revealed right lung mass; also noted was an intra-uminal growth causing partial luminal obstruction (black arrow) in right principal bronchus just below the level of carina Click here to view She later presented in an emergency room with complaints of dyspnea[indianjcancer.com]
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]
  • cough乾性咳[嗽]、痰を伴わないせき duration持続 dysphagia嚥(えん)下困難 dyspnea 呼吸困難 e eczema湿疹 edema水腫 embolus塞栓 emphysema肺気腫 emphysematous 気腫性 endobronchial気管支内 ex[s]udate滲出液 ex[s]udation滲出 exhalation呼気 expiration 呼気 expiratory 呼気の、呼息の expired air呼気 extubation抜管 f fibrosis[tokyo-med.ac.jp]
Painful Cough
  • The symptoms of atelectasis include: Difficulty breathing Rapid breathing Chest pain Coughing. Diagnosis and Treatment Atelectasis is routinely diagnosed using a chest X-ray to visualize the lungs and surrounding areas.[innerbody.com]
  • Acceleration atelectasis can cause symptoms like chest pain, coughing, and dyspnea. E.[medicowesome.com]
Blepharospasm
  • Clinical Case Report An 82-year-old woman with a history of diabetes mellitus type 2 and oromandibular and cervical dystonia with blepharospasm (Miege's syndrome). In 2010, she had a pure sensory right hemispheric lacunar transient ischemic attack.[archbronconeumol.org]
Dystonia
  • Clinical Case Report An 82-year-old woman with a history of diabetes mellitus type 2 and oromandibular and cervical dystonia with blepharospasm (Miege's syndrome). In 2010, she had a pure sensory right hemispheric lacunar transient ischemic attack.[archbronconeumol.org]
Meningism
  • Ferri’s popular "5 books in 1" format provides quick guidance on short QT syndrome, microscopic polyangiitis, fungal meningitis, and much more. This medical reference makes the answers you need even easier to find - anytime, anywhere.[books.google.de]

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.

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]
  • Chest X-ray revealed atelectasis of the right upper lobe (RUL) with ipsilateral mediastinal shift ( Fig. 1 ). X-ray on admission was normal. The respiratory unit was requested to perform bronchoscopy for resolution of the RUL atelectasis.[archbronconeumol.org]
  • Symptoms may include diminished breath sounds or aspiratory crackles, a mediastinal shift toward the side of the collapse, fever, and increasing dyspnea.[medical-dictionary.thefreedictionary.com]
  • shift") potential causes of resorptive atelectasis include obstructing neoplasms, mucous plugging in asthmatics or critically ill patients and foreign body aspiration resorptive atelectasis of an entire lung ("collapsed lung") can result from complete[radiopaedia.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]
  • Treatment for obstructive atelectasis aims to re-expand the collapsed portion of the lung. The treatment options include: Chest Physiotherapy: These exercises help people to breathe deeply after a surgery and can help normalize the affected lung.[home-remedies-for-you.com]

Prognosis

  • 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]
  • 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]
  • […] 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]
  • Etiology The causes of resorption (obstructive) atelectasis can be thought of in terms of where the obstructing lesion arising from with respect to the bronchial lumen: extra-luminal neoplasm lymphadenopathy bronchial fibrotic stricture neoplasm spontaneous[radiopaedia.org]
  • […] 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]
Sex distribution
Age distribution

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[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]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • Case studies revised to emphasize chronic diseases, prevention, and acute care, and to apply to a wider range of health professions. Appendices reorganized for improved reference and lookup.[books.google.de]

References

Article

  1. 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.
  2. Graham EA, Burford TH, Mayer JH. Middle lobe syndrome. Postgrad Med. 1948;4:29–34.
  3. Livingston GL, Holinger LD, Luck SR. Right middle lobe syndrome in children. Int J Pediatr Otorhinolaryngol. 1987;13:11–23.
  4. Proto AV, Tocino I. Radiographic manifestations of lobar collapse. Semin Roentgenol. 1980 Apr;15(2):117-73.
  5. 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.
  6. 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.
  7. 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.
  8. Stathopoulos GT, Karamessini MT, Sotiriadi AE, Pastromas VG. Rounded atelectasis of the lung. Respir Med. 2005;99(5):615–23.
  9. Batra P, Brown K, Hayashi K, et al. Rounded atelectasis. J Thorac Imaging. 1996;11(3):187–97.
  10. Partap VA. The comet tail sign. Radiology. 1999 Nov;213(2):553-4.

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Last updated: 2019-06-28 10:25