Atelectasis
Definition
Collapse of a lung or a part of it.
Alveoli deflated; reduced in volume
Results in reduced or absent gas exchange
Usually unilateral
Shown in X-ray of the chest
Causes
Pneumothorax
Pleural effusion
Surfactant deficiency
Premature neonate which leads to infant respiratory syndrome
Post surgical (abdominal) due to splinting - restricted breathing
Pulmonary Koch's
Smokers and the elderly are at increased risk
Blockage of a bronchiole or bronchus by mucus or foreign body, tumour, compression from the outside by tumour, lymph node, tubercle
Lack of surfactant action
Excessive suction during treatment
The different types are : Resorption, Compression, Microatelectasis and contraction atelectasis
Atelectasis may be acute or chronic
Acute : only airlessness
Chronic : airlessness, infection, widening of bronchi (bronchiectasis), destruction and scarring (fibrosis)
Signs and Symptoms
Sometimes asymptomatic
Cough
Chest pain
Breathing difficulty
Low oxygen saturation
Pleural effusion
Cyanosis
Tachycardia
The atelectatic part may develop pneumonia
Direct Signs
Displacement of Fissures towardS the segment with volume loss. most reliable direct sign
Increased Density
Crowding of the Bronchi.
Indirect Signs
Hilar Displacement.
Elevation of a Hemidiaphragm.
Shift of the Tracheal Shadow.
Mediastinal Shift. The shift will be toward the side of involvement.
Approximation of the Ribs.
Compensatory Hyperaeration.
Investigations
chest x-ray
CAT scan
Bronchoscopy
Treatment
Treat the underlying cause
Pleural Effusion : may need pleural tapping or Intercostal drainage
Pneumothorax : Intercostal Tube and underwater seal with/without suction
Physiotherapy - deep breathing exercises, coughing, incentive spirometer, walking
Assisted breathing with continuous positive airway pressure, mechanical ventilation
Removal of blocking secretions/FB by suctioning or bronchoscopy
Antibiotics for infection
Surgical excision of fibrosed/destroyed segment or lobe
Surgical removal of tumours
