Pleural Atelectasis

by Garreth Myers

The delicate membranes that surround the lungs are known as pleura. Pleura remain moist due to the presence of a thin fluid that helps prevent friction during the process of respiration. The pleural cavity refers to the space between the lungs and the wall of the chest. When fluid collects in the pleural cavity, it is known as pleural effusion. Pleural effusion can be caused by a number of conditions. Abnormal substances that may fill the pleural cavity include air, blood, plasma, serum or lymph, or pus. Any fluid that collects in the pleural space (with or without air) is prone to infection as a result of contact with the blood stream. Such infections can further aggravate the condition and lead to an abscess in the pleural space.

Apart from the collection of fluid in the pleural cavity, other possible causes of pleural effusion include:

  • Leakage of fluid caused by high pressure in the lungs. This happens in cases of congestive heart failure, liver disease, kidney failure and malnutrition
  • Pulmonary embolism or a blockage of the lungs may also lead to pleural effusion
  • Cancer of the lung
  • Atelectasis of the lung
  • Nephrotic Syndrome (large amount of protein in the urine)
  • Severe hypothyroidism
  • Pneumonia
  • Tuberculosis
  • Pancreatitis
  • Reaction to certain drugs
When any of these substances collect in the pleural space, the lungs become compressed and pleural effusion atelectasis occurs. Atelectasis may also be the cause of pleural effusion. Atelectasis is the condition where the alveoli in the lungs are devoid of air and collapse. Symptoms include chest pain, breathing difficulties and a chronic cough. Pleural atelectasis falls under the category of non-obstructive atelectasis. The different lobes of the lungs are affected in different ways in cases of pleural effusion atelectasis. The middle and lower lobes tend to collapse more than the upper lobe. Subpleural atelectasis rarely affects the elasticity of the lungs even thought the volume may decrease.

Diagnosis of Pleural Effusion and Pleural Atelectasis

Atelectasis caused by pleural effusion can be detected during a physical examination. Tapping the back can indicate fluid levels and a chest x-ray can confirm the diagnosis. A procedure known as thoracentesis may be performed where a needle is inserted between the ribs and the pleural fluid is collected and analyzed in a laboratory to check for infections.

Treatment

Treatment for pleural effusions will depend on the underlying cause of the condition. Infections are usually treated with antibiotics. Drainage of excess fluid may be carried out with chest tubes or surgery to remove the infected part of the lung tissue or lining. Diuretics are prescribed in cases where the pleural effusion is caused by leakage in the pleural cavity. A procedure known as pleurodesis is performed in cases where cancer or other diseases may cause a continuous build up of fluid. In this procedure, the spaces are regularly scarred down to prevent symptoms such as shortness of breath.

Methods to treat atelectasis include deep breathing exercises, postural drainage (where the person is tilted so the head is lower than the chest), inhaled medications and the use of PEP (Positive and expiratory pressure) devices.

Pleural atelectasis of the lung is usually not a life-threatening or dangerous condition. In cases where only part of the lung collapses, the rest of the lung still functions well enough to make up and supplies enough oxygen to the body. If the area of the collapsed lung is large, the condition will require immediate medical treatment. In cases of small children or babies with atelectasis or for people with other respiratory disorders, more aggressive treatment and hospitalization may be necessary. Treatment is generally successful and the collapsed area of the lung re-inflates and functions normally in time. There may be some amount of scarring and damage to the lungs however.

References:
  1. http://www.umm.edu/ency/article/000065all.htm#ixzz26Em1Ojtg

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