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Pulmonary atelectasis is defined as the collapse or obstruction of a part of the lung or in some cases the entire lung. The condition can be congenital or acquired due to various complications or disorders. Pulmonary atelectasis is one of the most prevalent lung abnormalities. Congenital or inborn pulmonary atelectasis is more common in premature and weak infants. The other causes that can provoke the congenital pulmonary atelectasis are birth injury to the nervous system, extended or arduous labor, narcotization, inhaled amniotic fluid, or meconium. Acquired pulmonary atelectasis or secondary atelectasis is generally a result of compression or obstruction.

Symptoms

• Irregular or difficult breathing
• Fast or arrhythmic breathing
• Chest pain
• Coughing
• Infection
• Fever
• Discoloration of skin (bluish, a result of less oxygen levels)

Causes

The main causes that can precipitate pulmonary atelectasis are as follows.

• Pulmonary edema (fluid in the lungs or surrounding the lungs)
• Lung infection
• Obstruction of lung airways due to foreign object, mucus or tumors
• Compression due to damaged and enlarged air sacs (emphysema), a tumor, or an enlarged heart
• The collection of air or gas in the space between the chest wall and the lungs
• Scarring or due to infections, diseases, injuries or radiation therapy
• Lung impediment in premature and weak infants
• Limited movement due to surgery and muscle or bone disorders
• Sedation or anesthesia
• Severe scoliosis
• Neuromuscular disorders

Diagnosis

The diagnosis of the pulmonary atelectasis includes:

• Oxymitery (a noninvasive technique to calculate oxygen levels in the blood)
• Arterial blood gas (ABG) to measure blood characteristics such as acidity, pH, carbon dioxide, oxygen
• Pulmonary function tests to specify the measure of intake and release of air and gases in the lungs
• CT scan to specify compression in the lungs and to detect any underlying disease or complication leading to pulmonary atelectasis
• Chest radiography
• Bronchoscopy to reveal the type of congenital obstruction lesion (the procedure could also be a likely treatment for the clearance of foreign bodies from the lungs with rigid bronchoscope)

Physical Signs

The signs of reduced lung volume in radiological studies are as follows:

• Shift of mediastinum, drooping of shoulder, narrowing of ribs, and upwards movement of diaphragm
• Forward or backward movement of fissures
• Movement of hilum
• Disproportionate right and left lung
• Compensatory hyperinflation
• Bowing sign
• Open bronchus sign
• Inverted comma sign

Treatment

The treatment of pulmonary atelectasis includes the following options:

• Inhaled bronchodilators and oral corticosteroids to treat inflammation and bronchial spasms
• Chest physiotherapy and postural drainage to ease mucous plugs
• Installation of deoxyribonuclease (DNAse) by way of bronchoscope or a nebuliser to remove secretions
• Antibiotics (for children with asthma)
• Mechanical ex-insufflator (cough assist) to cleanse the airways
• Pain therapy or management (if the cause of atelectasis is pain)
• Surgery

Risk Factors

The prominent factors that increase the chances of pulmonary atelectasis are

• Lung diseases (asthma, emphysema, pulmonary edema, lung cancer)
• Premature birth
• Old age
• Heart failure
• Smoking
• Inactivity due to illness or trauma
• Injury
• Obesity
• Scoliosis

Complications

• Pneumonia
• Lung scarring
• Low oxygen levels (hypoxemia)
• Respiratory failure

Prevention

The steps to prevent pulmonary atelectasis include:

• Quit smoking
• Weight management
• Timely treatment for lung infections and diseases
• Proper prenatal care for pregnant women
• Monitoring infants and children (for inhalation of foreign bodies such as small toys, peanuts and marbles)
• Postoperative care such as deep breathing, movement, coughing, and pain management

The complete treatment of pulmonary atelectasis depends upon the underlying cause of the disorder. A detailed consultation with a physician or a medical practitioner will help in the correct prognosis of the condition. In some serious cases of pulmonary atelectasis, the services of a pulmonologist or a lung specialist may be required.  

References:

1. www.ncbi.nlm.nih.gov

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