Atelectasis: Symptoms, Causes, and Treatment
Atelectasis is not a household name and many people would probably freak out and be confused if they are told that they have it. You are probably wondering what it means and what its causes are.
To define atelectasis, we can say that it is a medical condition where a portion or all of your lungs collapses. The condition develops as a result of lack of fresh air in the alveoli, where the exchange of oxygen and carbon dioxide takes place. When this happens, the oxygen levels in the body's organs drops to a minimum. The condition wherein the body's organs do not have enough supply of oxygen is known as hypoxia.
Atelectasis may develop suddenly within minutes (acute) or can take days or even weeks to develop (chronic).
Atelectasis symptoms
Atelectasis may come with very few symptoms or fail to produce any symptoms at all if it emerges at a slow pace, or if it affects just a small fraction of your lungs. Alternatively, if there is lung impaction in the large fraction of your lungs or if it grows at a high rate, the symptoms can be so severe that can even lead to shock. Below are some of the common symptoms that may accompany atelectasis:
- Difficulty in breathing - This is probably the most common symptom of atelectasis.
- Coughing - In most cases, you may experience a dry cough as a symptom. The coughing may sometimes be referred to as hacking.
- Fever - An increase in body temperature may be experienced as a symptom in very rare cases.
- Pleurisy - This is a sharp chest pain that gets worse when coughing or breathing deeply (pleuritic chest pain).
- Cyanosis - This is when the skin turns bluish, especially in the toes, fingers, and lips as a result of inadequate supply of oxygen in the blood.
- Shock - If the condition affects a huge part of your lungs or if it develops at a faster rate, symptoms such as increased heart rate and low blood pressure may be observed.
Atelectasis causes
There are four main causes of atelectasis. They are:
1) Obstruction - A part of the lung may collapse when an airway is blocked either from the outside or the inside. It may be blocked by lung cancer from the outside or by a foreign substance from the inside.
2) Compression - The airways can be compressed by air or fluid surrounding the lungs, by metastatic cancer or any other tumor in the lungs, by pressure caused by abdominal distension, lymphomas, or when lymph nodes are enlarged.
3) Hypoventilation - A part of the lungs can collapse as a result of lack of deep breaths. This is one of the most common causes of atelectasis, and in most cases, it happens during surgery when a patient is under general anesthesia. It can also occur when breathing gets shallow as a result of pain.
4) Adhesion - The lungs can also collapse due to a lack of surfactant, which is the substance that holds open the alveoli. When there is not enough surfactant, the surface tension in the lungs is lost. This is said to be the prominent cause of respiratory complications in infants. An adult can also lose surfactant in the lungs as a result of inhaling too much smoke, kidney failure, or a condition referred to as ARDS (acute respiratory distress syndrome).
Risk factors
Risk factors are the factors that can increase your chances of developing a condition. In the case of atelectasis, anything that interferes with the deepness of your breath causes compression to your lungs or can cause obstruction in your airways will put you at risk of developing atelectasis.
- Surgery - is one of the common causes of atelectasis, especially the one involving your upper abdomen or chest.
- General anesthesia - may interfere with the deepness of your breath, which may lead to atelectasis.
- Pleural effusions - the airways may be compressed by both malignant and benign pleural effusions.
- Lung conditions - such as cystic fibrosis and chronic obstructive pulmonary disease (COPD) can release mucous plugs that may block the lungs leading to the collapse of parts of it.
- Tumors - metastatic cancer and other forms of tumors such as lymphomas and lung cancer including tumors from other parts of the body may increase your chances of developing atelectasis.
- Chest injuries and rib fractures - these kinds of injuries may interfere with your breathing and that will definitely increase your chances of getting atelectasis.
- Inhalation of a foreign substance - foreign objects such as peanuts may block your airways.
- Lack of surfactant - the same condition with ARDS and respiratory distress syndrome (RDS).
- Exposure to asbestos - this can be as a result of contraction and scarring of the pleura (lining of the lungs).
- High G’s - people who spend a lot of their time in high altitudes such as pilots and astronauts are at high risk of developing atelectasis.
- Sedatives and narcotics - excessive doses of sedatives and narcotics can significantly affect your breathing.
- Obesity - is the root of a whole lot of health conditions and atelectasis is one of them. Obesity in the abdominal area exerts pressure under the lungs.
- Tight bandages - can interfere with respiratory function, which increases your chances of developing atelectasis.
- Smoking
- Age
Diagnosis of atelectasis
If your symptoms or risk factors suggest that you may be having atelectasis, your doctor may have to put you under further tests. These tests may include:
- Physical examination - Your doctor may look for physical findings that confirm atelectasis such as absent or quiet breath sounds. Your doctor may also listen for sounds that come with the condition through tapping on your chest.
- Chest X-ray - This imaging test is one of the most common ways of identifying atelectasis. When a section of your lung collapses, there can be a deviation of the heart and trachea towards the affected area. The diaphragm may as well deviate toward the chest side where the affected lung is.
- CT scan - A CT scan of the chest may also go a long way in confirming the presence of atelectasis. It can as well be used in the detection of other conditions such as enlarged lymph nodes or tumors.
- Bronchoscopy - This is a test that involves placement of a fiber-optic scope down to the bronchi via the mouth. It is a good way of determining the cause of a bronchial obstruct. It can act as a treatment method for bronchial obstruction by removing any foreign objects or mucous plugs.
- Blood gases - This test can be used to tell the level of damage that atelectasis has caused in your respiratory system.
Depending on the extent of your condition and the results of the other tests, other tests such as an MRI and PET scan for cancer may be done for further examination.
Atelectasis treatment
The treatment method used to cure atelectasis will greatly depend on the cause. The main purpose of the treatment is to rebuild the collapsed fraction of the lungs. For example, chemotherapy or radiation therapy may be recommended if the cause of the collapse is a tumor.
If a foreign object, tumor, or mucous plug is the cause of atelectasis, bronchoscopy may come in handy to help remove the blockage. Chest percussion and postural drainage may also help in the treatment process. If the compression in the lungs is as a result of pleural effusion, the recommended treatment would be effusion drainage.
In a situation where breathing is a problem, an incentive spirometer may help in encouraging deep breathing. You may be advised to lie on the side with the healthy lung to encourage expansion of the blocked side. You may also be prescribed with bronchodilators, which are the medications used to expand the airways.
A treatment known as positive end-expiratory pressure (PEEP) may also come in handy. This treatment involves the use of an oxygen mask that pushes the oxygen into the lungs to prevent it from completely collapsing. In the case where there is a detection of infection, antibiotics may be prescribed. Steroids may also be used in case of inflammation. Ventilation and intubation may be used to control the situation if symptoms prove to be severe. Fixing the collapsed part of the lung may be difficult if the atelectasis is chronic. This may force the doctors to use extreme measures of treatment such as segmental resection or lobectomy, which involves the removal of the affected part of the lung.
Prevention
Prevention of atelectasis is normally possible in some cases. Frequent changing of positions, moving around the soonest time possible after undergoing surgery, and using incentive spirometry are all possible preventive measures. For smokers, quitting for 4-8 weeks prior to surgery reduces the chances of developing atelectasis.
Complications
One of the complications that may be observed is a bacterial infection in the collapsed section of the lungs, which may lead to sepsis and pneumonia. Another common complication is bronchiectasis, which happens when the airways widen abnormally leading to the pooling of fluid in the lungs. This is mostly seen in children. Respiratory failure may occur in cases when there is a large portion of lung impaction.
Basilar atelectasis
Basilar atelectasis can be defined as a lung condition wherein a part or the whole lung collapses as a result of blockage or obstruction of the airway.
How basilar atelectasis affects your lungs
It is necessary that you get to know how your lung operates before you try to understand this condition. Every human being has two lungs, one on the right and the other on the left. The left lung is partitioned into two parts (lobes) while the right is partitioned into three lobes. The lungs are comprised of tiny air sacs known as the alveoli, where the gas exchange takes place.
Basilar atelectasis condition happens when the lower part of your lung collapses due to an obstruction affecting the gas flow process.
Bibasilar atelectasis
There are a number of causes that can lead to this condition. Below are a number of common causes:
- General anesthesia given during surgery is one of the common causes of this condition.
- Taking medications that can suppress coughing, since they prevent the obstructions in the lungs from getting out.
- Obesity
- Blockage of the airway by foreign objects, allergens, or mucus.
- Shallow breathing
- Lung complications such as pneumonia
- Lung tumor
- High lung pressure
- Chest injuries
Bibasilar atelectasis symptoms
Bibasilar atelectasis affects just a small section of your lung and does not show many symptoms in a good number of cases. However, there are a number of symptoms that may be observed if the affected area becomes bigger. Below are some of the symptoms:
- Breathing difficulties, especially when in specific positions
- Difficulty in the expansion of the chest when breathing
- A cough that produces sputum
- Fever
- Wheezing
A number of additional symptoms may be observed if the condition gets worse. These symptoms include:
- Sharp pain in the affected area
- Skin turns blue
- Extreme breathing difficulties
- Anxiousness
- Increased heart rate
Treatment
This condition is mostly reported in people who have just undergone surgery. For this reason, necessary preventive measures such as quitting smoking for around two months prior to the surgery will greatly reduce the possibility of developing the condition.
If an obstruction is the cause of the condition, removal of the obstruction will solve the problem in most cases. Oxygen therapy may be included in the treatment if a huge part of the lung is affected. This will help the lungs get their much-needed oxygen.
It is advisable to contact your doctor immediately in case you encounter any of the above-mentioned symptoms.
Subsegmental atelectasis
This is a condition wherein the volume of the lung decreases as a result of an impediment of the subsegmental (small) bronchus. This condition appears as a linear opacity when a radiograph is performed on the chest. A number of people that suffer from hypoventilation, pulmonary embolism, and respiratory tract infection are affected by subsegmental atelectasis.
Symptoms
- Coughing
- Low fever
- Fast and shallow breathing
- Breathing difficulties
The causes of this condition are the same with atelectasis.
Atelectasis vs. pneumothorax
Atelectasis is a condition in which a small area or the entire lung collapses while pneumothorax is when there is air in the pleural cavity. The pleura is a protective covering located outside of the lungs and inside the chest cavity. The pleura comprises of two layers and the space between them is referred to as the pleural cavity, which is also the one separating the lung from the chest.
Difference in causes
Atelectasis is common in people who have just undergone surgery. Moreover, it is as a result of alveoli (air sacs) deflation. Pneumothorax is one of the main causes of lung collapse. Atelectasis develops as a result of blockage of air passages by mucous plugs, foreign objects, or tumors found in the airways or walls.
Pneumothorax is a condition that results from a fractured rib or an injury of the chest wall by a sharp object. In slim, tall people, the rupturing of air sacs that are small and filled with air, called blisters, exposes air to the pleural cavity resulting to spontaneous pneumothorax. Pneumothorax can also be caused by damage made to the lungs due to asthma, tuberculosis, and pneumonia. The risk factors that can increase your chances of getting pneumothorax include drug use and smoking.
Difference in signs and symptoms
In pneumothorax, patients exhibit the following symptoms: stabbing chest pains, dry cough, and breathlessness. Chest pains normally become severe as one continues to inhale. In the case of tension pneumothorax, the air inhaled leaks to the pleural cavity but does not exhale. Thus, such condition is considered as a medical emergency, especially when it comes with an increased pulse rate, increased heart rate, rapid breathing, and a bluish skin discoloration.
To further differentiate the conditions, CT scans and X-rays will be recommended. For pneumothorax, the trachea usually shifts to the opposite side, while in atelectasis, the windpipe or trachea shifts to the side that is affected.
Difference in treatment
If atelectasis is as a result of a blocked lung, then bronchoscopy can be done. Bronchoscopy involves the insertion of a thin flexible tube that runs all the way to the airway from the nose to clear the blocked air passage. If the cause is a collapsed lung, then chest physiotherapy is recommended where you will be required to exercise deep breathing. In cases when there is a tumor, the tumor is surgically removed after chemotherapy or radiotherapy is recommended. Moreover, antibiotics are prescribed for the treatment of infection. For sputum removal, bronchodilators are given.
In the case of pneumothorax, the cause is focused on the treatment. Normally, air suction is done through the aid of a chest tube that is inserted into the chest cavity. In emergency cases, air is exhaled from the chest cavity by insertion of a needle. In case the cause was a bacterial infection, antibiotics are administered. In some cases, oxygen therapy is given.
Prognosis
Prognosis depends on the cause and the involvement of the lungs. If the lungs are affected in a minor way or in a case where the lungs have mildly collapsed, the prognosis is excellent. Atelectasis is considered life-threatening when the symptoms arise abruptly or if the condition involves a number of airways.
