Massive Pulmonary Atelectasis: An Overview

What Is Atelectasis?

In breathing, the lungs take in air, and then the oxygen from the lungs is delivered to the tissues and organs through the bloodstream. Atelectasis is the term used for a complete or partial collapse of the entire lung or an area of the lung. The air breathed in travels to the alveoli (air sacs of the lungs), from where the oxygen is moved into the blood. The blood then delivers oxygen throughout the body. Atelectasis occurs when these air sacs or alveoli get deflated or get filled with alveolar fluid. It develops most commonly as a complication of surgery or possibly due to other respiratory problems. If much of the lung is affected, the blood may not receive enough oxygen to deliver to the cells, leading to several health issues apart from difficulty breathing.

What Are the Symptoms of Atelectasis?

If only a small lung area is affected by atelectasis, there may not be any visible symptoms. But if larger areas are affected, the lungs would be unable to fill enough air, and the oxygen level in the blood will get too low. In this condition, one may experience uncomfortable symptoms, which may include-

• Difficulty breathing (shortness of breath).

• Increased heart rate.

• Rapid, shallow breathing.

• Coughing.

• Chest pain.

• Bluish discoloration of the skin and lips.

What Causes Atelectasis?

Atelectasis can occur due to blockage in the airway (obstructive) or pressure on the lungs from outside (non-obstructive). General anesthesia is a common cause of atelectasis. It causes a change in the regular pattern of breathing as well as has an effect on the exchange of lung gasses causing the air sacs in the lungs (alveoli) to deflate. Nearly everyone undergoing some major surgery develops some amount of atelectasis. For example, it is the most common occurrence after a heart bypass surgery.

Obstructive type of atelectasis can be caused by many things, including-

• Mucus Plug- A mucus plug is an accumulation of mucus in the airway. It is commonly observed during and after a surgical procedure because of the patient’s inability to cough. Drugs administered during surgery make breathing less deep, so normal secretions get collected in the airways. During surgery, the lungs' suctioning helps clear up the mucus, but sometimes they still build up. Mucus plugs are also commonly observed in people with cystic fibrosis (a life-threatening genetic disorder damaging the lungs and digestive system), during severe asthma attacks, and in children.

• Foreign Body- Atelectasis is also commonly seen in children who have inhaled a foreign object, such as a peanut or a very small toy part, into the lungs.

• Tumor- A tumor or abnormal growth can lead to the narrowing of the airways.

Various possible causes of nonobstructive atelectasis include-

• Injury- Trauma to the chest, for example, from a fall or due to a car accident, can make you avoid taking deep breaths due to the chest pain, which can lead to compression of the lungs.

• Pleural Effusion- This condition involves the building up of the fluid between the tissues that line the lungs (pleura) and the inside of the chest wall.

• Pneumonia- Various types of pneumonia (a lung infection) can cause atelectasis.

• Pneumothorax- In this condition, the air gets leaked into the space between the lungs and the chest wall, indirectly leading to some or all of the areas of the lungs collapsing.

• Scarred Lung Tissue- Scarring of the lung tissue could be due to injury, lung disease, or surgery.

• Tumor- A large tumor can put pressure against the lungs and deflate them instead of blocking the air passages.

What Are the Risk Factors for Atelectasis?

Some people are more likely to develop atelectasis than others. Factors that raise your chances of it include-

• Older age.

• Long-term bed rest with infrequent changes in positions.

• Any illness or condition that makes it difficult to swallow.

• Lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD).

• Recent chest or abdominal surgery.

• Recent general anesthesia.

• Medications that may lead to shallow breathing.

• Conditions that cause damage to the nerves and muscles, such as spinal cord injury and muscular dystrophy.

• An injury that makes coughing painful or causes shallow breathing, including stomach pain or rib fracture.

• Smoking.

How Is Atelectasis Diagnosed?

If a healthcare provider suspects atelectasis, they will probably recommend the following tests-

• Chest X-Ray- A partly or entirely collapsed lung will appear white on the image.

• Computed Tomography (CT) Scan- CT scan, being more sensitive than an x-ray, gives a better picture to determine the cause and the type of atelectasis.

• Ultrasound- An ultrasound of the thorax can help differentiate between atelectasis, lung consolidation (swelling and hardening of the lungs due to fluid-filled air sacs), and pleural effusion.

• Bronchoscopy- A thin, flexible tube with a light and a camera is inserted down the throat to look into the air passage and find what would be causing a blockage, such as a mucus plug, a tumor, or a foreign body.

• Oximetry- It measures how much oxygen is there in the blood.

How Is Atelectasis Treated?

If a tumor or any underlying health condition is the cause of atelectasis, a doctor will treat it.

The treatment options for atelectasis include-

• Bronchoscopy to clear out blockages such as the mucus plug.

• Medications such as an inhaler help to loosen and thin the mucus.

• Chest physiotherapy such as-

• Performing deep breathing exercises (incentive spirometry).

• Positioning the body in such a way that the head is lower than the chest allows better mucus drainage (postural drainage).

• Tapping the chest to loosen the mucus over the collapsed area (percussion).

• Surgery with or without cancer therapies to remove any tumor that may be causing atelectasis.

• Continuous positive airway pressure (CPAP) machine for people who are too weak to cough and have low levels of oxygen after surgery.

Conclusion:

Atelectasis is a partial or complete collapse of the lungs. This can be due to some airway blockages or pressure on the lungs from outside. Once the cause has been treated, people with atelectasis recover quickly and have no grave, long-lasting effects. However, if not appropriately treated, the condition can have permanent damage.