Compressive Atelectasis

by Garreth Myers

Atelectasis is a condition that describes a collapsed lung. Lung collapse means all or part of the lung is deflated. It is similar to a balloon with the air let out. The causes of atelectasis range from a trivial cause such as mild lung collapse seen with prolonged bed rest to serious conditions like blockage of the whole lung due to a tumor in the airway.

There are three main factors that can cause atelectasis: obstruction, adhesive, and compression. When an object like food gets stuck in the airways resulting in a blockage (air does not reach the lung), lung collapse occurs. This is known as obstructive atelectasis. Mucus developed from diseases and tumor can also block the airway.

Lack of surfactant results in adhesive atelectasis. In order to reduce the surface tension created by water that is coated in alveoli, surfactant is crucial. Surfactants are crucial for efficient exchange of air in the alveoli. An air exchange becomes labored without surfactant, resulting in the lung collapse.

When something presses against lungs to let out the air in the alveoli, compressive atelectasis occurs. It occurs when there is an obstruction in the area between the lungs and chest wall due to mass, fluid, or air.

Definition


Compressive atelectasis is a condition that develops when a patient’s lung cannot fully inflate owing to any space-occupying lesion. The lesion impinges upon the lungs and limits the volume of air that the patient can inhale with a given breath. It occurs when the pleural space is occupied by fluid or a lesion that forces air out of the tiny alveoli air sacks. Thus, the lung deflates due to the loss of connection between the inner and outer pleura. When the pleura is not connected, the patient will struggle to fill the lung and the lung may remain flat or partially inflated.

Causes of Compressive Atelectasis


Distension in the abdomen is one of the prime causes of compressive atelectasis. Other causes include the following:

  • Respiratory disorders such as pleural effusion
  • Surgical complications
  • Severe injury
  • Pneumothorax
  • Lung diseases that lead to the chest wall, pleura, or intraparenchymal masses
  • Buildup of pleural fluid
  • Lung cancer

Symptoms of Compressive Atelectasis


Common symptoms of compressive atelectasis are as follows:

  • Difficulty in breathing
  • Gasping
  • Wheezing
  • Chest discomforts like chest pain
  • Diminished breathing sounds
  • Shallow breathing
  • Dullness to percussion
In some cases, additional respiratory complications such as bronchiectasis, acute pneumonia, hypoxemia, and respiratory failure may develop.

Treatment for Compressive Atelectasis


Atelectasis of a small area may subside without treatment. However, if there’s an underlying condition like a tumor, it should be addressed. Treatment options vary depending on the underlying cause. It involves addressing the cause by providing medications. Physiotherapy, breathing exercises, and respiratory support are included to treat the underlying cause. In some cases, a bronchoscopy is needed to examine the mass, and surgery is recommended to remove the mass to restore normal lung function.

Atelectasis due to post surgery complications can be treated by physiotherapy. Deep breathing, coughing, and clapping on chest help people breathe deeply after surgery. Shortness of breath can be addressed by supplementing with oxygen.

Medications such as inhaled bronchodilators that help to open bronchial tubes of the lungs can make breathing easier. To remove cough, medications like acetylcysteine can be used.

People with chest deformities may benefit from mechanical devices that aid breathing. Mechanical ventilators are used as additional respiratory support. Blockages that cannot be removed by coughing and other methods can be removed with a bronchoscopy.

Prevention

  • Stop smoking as smoking increases mucus production and damages the cilia in the bronchial tubes.
  • Small objects should be kept out of reach for young children.
  • Deep breath exercises and frequent coughing after surgery help to decrease atelectasis risk.
  • For prolonged bed rest, changing the position frequently as movements help to avert atelectasis condition.

References:
  1. http://www.nlm.nih.gov/medlineplus/ency/article/000065.htm
  2. http://www.ncbi.nlm.nih.gov/pubmed/3756324

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