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atelectasis
Collapse of a lung or lung segment occurs secondary to resorption of air behind an obstructed bronchus.
Etiology:
1) aspirated foreign body
2) inspissated mucus
a) generally postoperative
b) mechanical ventilation [1]
3) endobronchial tumor, usually bronchogenic carcinoma
4) compression of the bronchus by enlarged hilar lymph nodes
4) hemicolectomy (case report) [3]
Clinical manifestations:
1) inspiratory chest expansion lag on affected side
2) decreased fremitus
3) dullness or flatness to percussion
4) breath sounds may be absent over affected region
5) persistent lower lobe crackles
6) low-grade fever
Radiology:
- trachea & heart may be shifted towards affected side
- opacification behind the heart obscuring the hemidiaphragm
- displacement of the mediastinum
- on the lateral image, an anterior triangular opacity represents atelectasis of the right middle lobe*
* right middle lobe atelectasis occurs more frequently than it does in other lobes
Management:
- correct underlying disorder
- chest physiotherapy
- incentive spirometry [3]
- ambulation (early mobilization after surgery)
- non-invasive positive pressure ventilation
- BiPAP for atelectasis from hypoventilation due chest wall restriction (kyphosis, scoliosis, ankylosing spondylitis)
- PEEP if mechanical ventilation with endotracheal tube
General
lung disease
sign/symptom
References
- Introduction to Clinical Imaging, Radiology Syllabus, UCSF,1993
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1146
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17.
American College of Physicians, Philadelphia 2012, 2014
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Marini JJ.
Acute lobar atelectasis.
Chest. 2019;155:1049-58.
PMID: 30528423