Overview
Any cause of atrophy or atelectasis of all or part of the lungs may be asymptomatic in mild cases, but in more severe cases there may be symptoms such as chest tightness, dyspnea, coughing, chest pain, etc. The causes of the disease include congenital developmental defects as well as acquired factors such as tumors, inflammation, and traumatic injuries.
Definition
A pathological condition in which a lobe, segment, or even the whole lung loses its volume and air content, and the lung tissue atrophies for any reason.
If the lung tissue has not completely atrophied, it is called pulmonary atelectasis, but it is difficult to distinguish the two clinically, so they are collectively called pulmonary atelectasis.
Classification
According to the time of onset, pulmonary atelectasis can be divided into congenital pulmonary atelectasis and acquired pulmonary atelectasis; according to the cause of the disease, it can be divided into obstructive pulmonary atelectasis and non-obstructive pulmonary atelectasis; according to the range of anatomical location, it can be divided into one-side pulmonary atelectasis, lobar pulmonary atelectasis, segmental pulmonary atelectasis and lobar atelectasis.
Classification according to the time of onset
Congenital pulmonary atelectasis
Less common.
Refers to the absence of gas filling in the alveoli of the fetus at birth.
Acquired atelectasis
Common.
Refers to all non-congenital lung atelectasis.
Strictly speaking, acquired pulmonary atelectasis should be called pulmonary atrophy, but the traditional or common term is still called pulmonary atelectasis, so this term is used in this article.
Classification according to the cause
Obstructive atelectasis
More common.
It is caused by obstruction of the trachea and bronchial tubes due to various reasons.
Non-obstructive pulmonary atelectasis
Less common.
Includes compression, passive, adhesion, scarring, and discogenic atelectasis.
Classification according to anatomical site
Unilateral atelectasis
Unilateral atrophy of lung tissue.
Mostly due to obstruction of the main airway on the affected side.
Lobar atelectasis
Atrophy of lung tissue in one of the lobes.
The obstruction is located in the bronchi of the affected lobe.
Segmental atelectasis
Atrophy of lung tissue in one of the lung segments, with a reduction in the size of the segment.
The obstruction is located in the bronchioles of the affected lung segment.
Segmental atelectasis alone is rare.
Lobar atelectasis
Atrophy of lung tissue in one of the lobules.
The obstruction is in the affected terminal bronchioles.
Causes
Causes
The causes of atelectasis vary from one type of atelectasis to another.
Obstructive atelectasis
Obstruction in the lumen of the bronchial tubes
Tumors growing in the bronchial tubes can cause partial or complete obstruction of the bronchial tubes.
Infectious lesions such as endobronchial tuberculosis can lead to inflammatory granulomas or scarring and adhesions within the bronchi, which can obstruct the bronchi.
Sputum plugs, mucus plugs, clots, etc. may obstruct the bronchi.
Bronchial foreign bodies can obstruct the bronchial lumen.
Bronchial lumen external pressure obstruction
Tumors and enlarged lymph nodes around the bronchial tubes compress the adjacent bronchial tubes, which can lead to narrowing of the bronchial lumen or even complete obstruction.
Non-obstructive pulmonary atelectasis
Compressive atelectasis
Intrapulmonary tumors, pulmonary pustules, pneumocysts and other lesions may compress the surrounding lung tissue and cause pulmonary atelectasis.
Passive pulmonary atelectasis
Pleural effusion, pneumothorax, intrathoracic tumor, elevated diaphragm, thoracic collapse (congenital deformity or trauma), pulmonary herpes and other factors can push and squeeze the adjacent lung tissues, resulting in pulmonary atelectasis.
Adhesive lung atelectasis
Inadequate development of the respiratory system in preterm infants, acute respiratory distress syndrome, pulmonary embolism, pulmonary hyaline membrane disease and other factors can lead to insufficient production or reduced activity of alveolar surface active substances, resulting in insufficient alveolar surface tension and causing pulmonary atelectasis.
Scarring pulmonary atelectasis
Chronic nonspecific inflammation of the lungs, such as tuberculosis, fungal infection, pneumoconiosis, bronchiectasis, and connective tissue disease, can lead to scarring and fibrosis of the affected lung tissues, resulting in crumpling of the affected lung tissues and reduction of their capacity, which can cause pulmonary atelectasis.
Round lung atelectasis
Asbestos pleurisy may lead to fibrous degeneration and thickening of the pleura or interlobular septa of the dirty layer, and invagination of the pleura, limiting the full reexpansion of the lung tissues and causing pulmonary atelectasis.
Discoid lung atelectasis
When the diaphragmatic motion is weakened due to various reasons, such as pleural effusion and obesity, it will restrict the normal reexpansion of lung tissue, resulting in pulmonary atelectasis.
Pelvic atelectasis
Long-term bedridden patients with shallow respiration, impaired mucus cilia transport system, or increased lung weight due to pneumonia, pulmonary edema and other pathologies can lead to incomplete lung expansion and cause pulmonary atelectasis.
Predisposing factors
Surgery
Lung surgery may lead to conditions such as bronchial stenosis, pleural effusion, pneumonia, and prolonged bed rest, which may cause pulmonary atelectasis.
Symptoms
Main Symptoms
Symptoms in patients with pulmonary atelectasis are closely related to the cause of the disease, the extent of involvement, and the urgency of onset. For patients with a slow onset of atelectasis and a small area of involvement, there are usually no symptoms. For patients with a more acute onset of atelectasis or a larger area of involvement, the following symptoms may occur.
Chest tightness and dyspnea
Difficulty in breathing is caused by the impairment of the normal ventilation and air exchange function of the lung tissues.
Chest tightness and dyspnea often appear or worsen after activity or emotional excitement, and can be relieved after rest.
In some severe cases, chest tightness and dyspnea may occur at rest.
Cough
Patients may have an irritating dry cough, and may cough up sputum when combined with infection.
Chest pain
Patients may experience chest pain on the affected side.
Chest pain may be aggravated by coughing or deep breathing.
Palpitations
Patients may experience tachycardia or arrhythmia due to hypoxia, causing palpitations.
Complications
Pulmonary atelectasis may lead to the following complications.
Obstructive pneumonia
Pulmonary atelectasis can lead to bronchial obstruction, preventing airway secretions from being expelled leading to obstructive pneumonia.
Patients may present with fever, chills, and coughing up sputum.
Blood test, C-reactive protein and calcitoninogen may show elevated inflammatory indexes, and chest imaging may show inflammatory exudation from the affected lung tissue.
Hemoptysis
Tumor, tuberculosis, inflammation and other primary diseases leading to pulmonary atelectasis may invade the bronchial mucosa or bronchial blood vessels, causing hemoptysis.
If the hemoptysis is large, it may lead to hemorrhagic shock or asphyxia endangering the patient’s life.
Respiratory failure
Involvement of a wide range of lung atelectasis will seriously affect the normal ventilation function of the lung tissue, causing the patient to develop respiratory failure.
Cyanosis, irritability, coma and other symptoms may occur.
Blood gas analysis shows a decrease in partial pressure of oxygen with or without an increase in partial pressure of carbon dioxide.
Inadequate treatment may result in death.
Consultation
Department of Medicine
Respiratory medicine
When pulmonary atelectasis is detected on physical examination, or when symptoms such as chest tightness, dyspnea, coughing and chest pain occur without any obvious cause, it is recommended to consult a doctor promptly.
Thoracic Surgery
The Department of Thoracic Surgery can also be consulted in the above cases.
Emergency Medicine
If symptoms such as severe dyspnea, agitation, severe cyanosis, or coma occur, you should consult the Emergency Department immediately or call 120 for emergency services.
Preparation for medical treatment
Preparation for medical consultation: registration, preparation of documents, common problems
Tips for seeking medical treatment
If chest tightness and dyspnea occur before medical treatment, try to keep bed rest, reduce activities and moving, and give low-flow oxygen if possible.
If hemoptysis occurs before consultation, please stay in bed, head tilted to one side, clear the secretion from mouth and throat in time to keep the airway open.
Preparation list for medical treatment
Symptom list
It needs to focus on the time of symptom occurrence, special performance, etc.
Are there symptoms such as chest tightness, dyspnea, cough, chest pain, palpitation, etc.?
Under what circumstances can these symptoms be aggravated or relieved?
Are there symptoms such as hemoptysis, irritability, cyanosis, coma, fever, etc.?
How long have these symptoms been present?
How often do these symptoms flare up or persist?
Medical History Checklist
Have there been any previous regular physical examinations? Any abnormal physical examination findings?
Any past history of lung tumors, inflammation, etc.? Any history of connective tissue disease?
Any previous long-term exposure to dust?
Have you ever inhaled foreign bodies?
Is there any history of lung cancer in the immediate family?
Checklist
Examination results in the past six months, which can be brought to the doctor’s office.
Imaging tests: chest radiograph, chest CT, etc.
Diagnosis
Diagnosis basis
Medical history
Some patients may have no relevant medical history.
Some patients may have a history of lung tumor, tuberculosis, inflammation, pleural effusion, inhalation of foreign body, surgery, etc.
Clinical manifestations
Symptoms
Mild cases may not have any clinical symptoms.
In more severe cases, there may be chest tightness, dyspnea, cough, chest pain, palpitation and other symptoms.
Signs
Mild cases may not have any physical signs.
Severe hypoxia may result in cyanosis of the lips and nail beds.
In patients with a larger range of involvement, there may be signs such as thoracic collapse, narrowing of the intercostal space, weakening of palpatory tremor, displacement of the trachea to the affected side, turbidity on percussion on the affected side, and weakening or disappearance of respiratory sounds on auscultation.
Bronchoalveolar breath sounds can be heard in patients with upper lobe atelectasis, and rales or wet rales can be heard on the affected side in some patients.
Chest imaging
Chest imaging is an important test for detecting pulmonary atelectasis, and should be performed in all patients with suspected pulmonary atelectasis.
Commonly used tests are chest X-ray and chest CT.
Chest X-ray shows increased density at the lesion, some patients can see cystic translucent areas, reduced volume of the affected lobe, changes in shape, contour or position, displacement of interlobar fissures to the affected side, sparse lung texture, narrowing of the lung gate, diaphragm uplift, narrowing of the intercostal space, etc. Chest CT can be more accurate than chest X-ray.
Chest CT can be clearer than chest radiograph, and can show the condition of lung atelectasis from multiple angles and layers, and has better diagnostic value than chest radiograph for the causes of lung atelectasis such as tumors, inflammation, and foreign bodies.
Fiberoptic bronchoscopy
Fiberoptic bronchoscopy can visually observe the condition of the bronchial tubes, and at the same time can take samples for examination, which is of great significance to the diagnosis of pulmonary atelectasis.
Laboratory Tests
Blood routine, C-reactive protein
It is of significance in the diagnosis of the etiology of pulmonary atelectasis.
If white blood cells, neutrophils and C-reactive protein are elevated, it often suggests the presence of infection.
Elevated eosinophils are often indicative of asthma or allergic diseases.
Blood Sedimentation
Elevated blood sedimentation may indicate infection or connective tissue disease.
Calcitonin
When bacterial infection is suspected, calcitonin may be further investigated.
Pathogenesis
When infection is suspected, pathogenetic testing can identify the causative organism and guide the use of medication.
Tumor markers
Tumor markers can provide reference basis for the diagnosis and differential diagnosis of pulmonary atelectasis.
Commonly examined items include gastrin-releasing peptide precursor (Pro-GRP), neural specific enolase (NSE), carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFR21-1), squamous cell carcinoma antigen (SCC).
If a patient has elevated levels of any of these tumor markers, especially if they are progressively elevated, the patient should be alerted to the possibility of lung cancer.
Thoracoscopy or mediastinoscopy
Thoracoscopy or mediastinoscopy can be used to diagnose atelectasis due to pleural or mediastinal lesions.
It is an invasive procedure and is usually not preferred.
Differential diagnosis
The differential diagnosis of pulmonary atelectasis focuses on the cause of the atelectasis.
Lung atelectasis due to bronchopulmonary carcinoma
Patients are mostly middle-aged or elderly, with a history of long-term heavy smoking or exposure to harmful gases and dust.
In addition to the clinical manifestations of pulmonary atelectasis, hemoptysis, weight loss and lymph node enlargement can also be seen.
Chest imaging can show pulmonary occupancy, tumor markers related to lung cancer can be elevated, and bronchoscopy can show neoplastic organisms in the airways.
Pathologic biopsy can clarify the diagnosis.
Lung atelectasis due to foreign body aspiration
The patient has a history of foreign body aspiration.
There may be severe irritating dry cough, chest tightness, dyspnea and other symptoms; if the large airways are obstructed, inspiratory dyspnea may occur, and rales may be heard on auscultation.
Foreign body shadow can be seen on chest imaging, and foreign body can be found in the airway by fiberoptic examination.
Pulmonary atelectasis due to sputum or mucus plugs
Most patients have a history of respiratory infection or prolonged bed rest.
In addition to symptoms of pulmonary atelectasis, fever, chills and coughing up sputum may be present.
Blood routine, C-reactive protein and calcitoninogen can be seen as elevated inflammatory indexes, and inflammatory exudation in the lungs can be seen on chest imaging.
Pulmonary atelectasis due to endobronchial tuberculosis
Patients may have a history of tuberculosis or close contact with tuberculosis.
In addition to the symptoms of pulmonary atelectasis, hemoptysis, night sweats, low-grade fever, and emaciation may also be present.
Tuberculosis foci can be seen on chest imaging, and tests such as PPD, T-cell test for tuberculosis infection, sputum search for antacid bacilli, sputum tuberculosis culture, and TB-DNA can help to clarify the diagnosis.
Pulmonary atelectasis due to pleural effusion and pneumothorax
Patients may have a history of pleurisy, intrathoracic tumors, pneumomediastinum, and chest trauma.
Symptoms such as dyspnea, cyanosis and chest pain may be present.
Chest imaging examination shows fluid and air accumulation in the chest cavity, which can make the diagnosis clear.
Congenital atelectasis
Congenital atelectasis is most commonly seen in premature infants and is present at birth.
Children may have cyanosis, shortness of breath, dyspnea and other symptoms.
Treatment
Aim of treatment: remove the factors causing lung atelectasis in time, and promote lung reopening as soon as possible.
Treatment principle: according to the causes of pulmonary atelectasis, carry out targeted etiologic treatment, at the same time, keep the airway open.
General treatment
The healthy side lying position, put the affected side in the high place, is conducive to reduce the compression, improve the symptoms.
Enhance the turning and patting of the back to promote the elimination of sputum, timely removal of oropharyngeal secretions, sputum suction if necessary, to maintain airway patency.
After the condition is stabilized, pulmonary rehabilitation therapy can be carried out under the guidance of professional respiratory rehabilitation therapists.
Treatment
Commonly used methods include medication, surgery, fiberoptic bronchoscopy and radiation therapy.
Drug treatment
Infectious diseases, tumors sensitive to drug therapy, bronchiectasis and other diseases caused by pulmonary atelectasis, drugs can be taken to treat the primary disease.
Specific drugs are related to the type of disease, such as amoxicillin, cephalosporins, levofloxacin, moxifloxacin and so on, due to bacterial infection, and anti-tumor drugs can be used due to tumor.
Drugs should be used under the guidance of a doctor.
Surgery
Surgery can be used to treat the cause of pulmonary atelectasis caused by tumor, pneumoperitoneum, effusion, trauma, etc. The specific surgery is related to the disease.
Specific surgical methods are related to the disease, such as thoracoscopic surgery or open thoracic surgery for tumors, and thoracentesis or closed thoracic drainage for air and fluid accumulation.
Fiberoptic bronchoscopy
It is suitable for lung atelectasis caused by foreign body or obstruction.
Foreign bodies can be removed through fiberoptic bronchoscopy, or tumors, granulomas, scar tissues in the airways can be removed to restore airway patency.
Radiotherapy
It is suitable for patients with lung atelectasis due to tumors that are sensitive to radiotherapy.
It can reduce the size of tumor and alleviate airway obstruction.
Symptomatic treatment
If there are symptoms of hypoxia, oxygen can be inhaled, and continuous positive airway pressure ventilation can be chosen if necessary.
If the sputum is sticky and not easy to cough out, nebulization can be used to dilute, or oral ammonium chloride and other sputum drugs.
If the amount of sputum is too much and not easy to cough out, bronchoscopy can be used to aspirate sputum, and tracheotomy can be considered if necessary.
Prognosis
Cure
The prognosis of atelectasis depends on the specific cause of atelectasis.
For patients with pulmonary atelectasis caused by inflammation, benign pleural effusion, pneumothorax, aspiration of foreign bodies and other benign lesions, as long as they receive timely and standardized treatment, most of them can be cured, so the prognosis is quite good.
For patients with lung atelectasis caused by malignant tumors, if they are diagnosed early and receive standardized treatment as soon as possible, the prognosis is still good and the five-year survival rate is high.
For children with congenital atelectasis, the treatment is more difficult, the mortality rate is high, and the prognosis is poor.
Daily
Daily Management
Dietary management
Avoid spicy and stimulating foods, such as chili, mustard and pepper, which may irritate the respiratory tract and aggravate the patient’s cough.
Avoid foods with high sugar content, such as desserts and beverages, etc., which may lead to thick phlegm that is not easy to cough up.
It is recommended to develop good dietary habits, maintain balanced nutrition, and eat more fresh fruits and vegetables to enhance immunity.
Drinking more water is recommended to help dilute the phlegm.
Daily care
Rest in bed and avoid strenuous exercise.
Assist the patient to turn over more often, and pat the patient’s back more often to promote the elimination of phlegm.
Clean up oropharyngeal and nasal secretions in time to keep the airway open.
Follow-up examination
Follow the doctor’s instructions for regular review of routine blood tests, C-reactive protein, tumor markers, chest imaging and other tests to assess the changes in the condition.
Prevention
Staying away from tobacco, strengthening exercise, avoiding aspiration, and encouraging coughing up sputum after surgery are effective measures to prevent pulmonary atelectasis caused by most benign diseases.
Stay away from tobacco
Smokers should strictly quit smoking, and non-smokers should avoid passive inhalation of second-hand smoke.
Exercise
Strengthen physical exercise and do more aerobic exercise such as running and swimming to increase lung capacity.
Avoid accidental inhalation
Children and people with swallowing disorders should be supervised and cared for to avoid accidental inhalation.
Encourage coughing and sputum after surgery
For postoperative patients, appropriate analgesic measures should be given to encourage patients to cough up sputum as early as possible and sufficiently.