Types and mechanisms of decline
Obstructive atelectasis occurs when the bronchus is blocked from the inside: the air stops flowing, and what remains is absorbed into the blood, and the lobe contracts. Compression develops when the lung is compressed from the outside by an accumulation of fluid, air or a large tumor. Contraction is associated with cicatricial changes in the pleura, which prevent the lung from expanding. Separately, atelectasis is distinguished after operations and anesthesia, when a person breathes shallowly, is afraid to cough, and the lower parts of the lungs cease to be ventilated.
- Obstructive - blockage of the bronchus
- Compression - compression from the outside
- Contraction - pleural scars
- Postoperative and hypoventilation
- Atelectasis of newborns due to lack of surfactant
- By volume: lobular, segmental, lobar, total
Causes and risk factors
In adults, a common cause of bronchial blockage is thick, viscous sputum, especially after surgery, with exacerbation of bronchitis and in bedridden patients. No less important is a bronchial tumor, which must be excluded in every smoker with newly diagnosed atelectasis. In children, aspiration of small objects and nuts, as well as compression of the bronchus by enlarged lymph nodes, come first. The compression variant develops with pleurisy, hemothorax and pneumothorax, as well as with large formations in the chest.
- Mucus plug in the bronchus
- Bronchial tumor or external compression
- Foreign body, especially in children
- Anesthesia, pain after surgery, shallow breathing
- Accumulation of fluid or air in the pleural cavity
- Prolonged immobility and weak cough
- Smoking and chronic lung diseases
Symptoms
Manifestations depend on the volume and speed of decline. Mild atelectasis may be asymptomatic and may be visible on imaging. When a lobe or the entire lung is switched off, shortness of breath, rapid breathing, a feeling of lack of air, and sometimes chest pain on the affected side appear. The skin may take on a bluish tint and the pulse quickens. Symptoms of the underlying cause are often present: cough with sputum, fever due to infection, hemoptysis due to a tumor. The addition of infection in an airless area causes fever and deterioration of the condition.
- Shortness of breath and rapid breathing
- Cough, often dry or with hard-to-clear sputum
- Chest pain on the affected side
- Increased heart rate
- Blueness with a large lesion volume
- Fever due to infection
- Lagging half of the chest when breathing
Diagnostics
Chest X-ray in two projections reveals a uniform darkening with a decrease in the volume of the lobe and a shift of the mediastinum towards the lesion - this distinguishes atelectasis from pneumonia and effusion. A CT scan more accurately shows the level of blockage and its cause. The key method for suspected obstruction in the bronchus remains bronchoscopy: it allows you to see the lumen, remove a mucus plug or foreign body, and take a biopsy of the tumor. Spirometry and pulse oximetry evaluate the effect on breathing.
- Chest X-ray in two projections
- CT scan of the chest
- Bronchoscopy - examination, sanitation, biopsy
- Spirometry
- Pulse oximetry
- Ultrasound of the pleural cavity for suspected effusion
- Sputum examination
Treatment and prevention
Treatment is aimed at eliminating the cause and promptly expanding the lung. The mucus plug is removed during bronchoscopy, the foreign body is removed endoscopically, in case of a tumor the issue of surgical or other treatment is decided, and in case of effusion, drainage is performed. Breathing exercises, coughing, changing body position, early activation after operations and inhalation through special simulators are required. It is important for smokers to quit smoking. For prophylaxis after surgical interventions, pain relief is used to allow full breathing and coughing.
- Bronchoscopic debridement and plug removal
- Removing a foreign body
- Drainage of the pleural cavity during effusion
- Treatment of bronchial tumor
- Breathing exercises and breathing simulators
- Early activation and change of body position
- Adequate pain relief after surgery
- Quitting smoking