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Pulmonary Atelectasis Clinical Presentation

  • Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Sep 21, 2015
 

History

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  • Most symptoms of pulmonary atelectasis are related to the underlying disorder.
  • Atelectasis alone only causes tachypnea as the child attempts to compensate for decreased tidal volume by increasing the frequency of respiration.
  • If the atelectasis is large enough, the child may grunt in an attempt to create auto–positive end-expiratory pressure (PEEP), both to improve oxygenation and to attempt to open the atelectatic areas.
  • If a child has underlying cardiopulmonary or neuromuscular disease and is on a monitor, sudden decreases in oxygen desaturation may be a sign of atelectasis. Atelectasis is one of the most common causes of sudden decreases in oxygen saturation in children.
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Physical

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  • Most findings upon physical examination are related to the underlying disorder. In one study comparing physical examination to chest radiography in children,[3] out of 35 children with radiographically proven atelectasis, the atelectasis was detected by physical examination in only 8.
  • Breath sounds may be decreased in the atelectatic portion of the lung, although the segment involved may be so small that the changes cannot be perceived. Also, the atelectatic portion may be in a segment inaccessible to the stethoscope.
  • If the atelectatic portion and chest wall are large enough, dullness to percussion may be detected.
  • The atelectasis may also occur in the right middle lobe or lingula in an adolescent girl. Because both are anteriorly located, the physician must listen to the anterior chest of the patient to hear these lobes. If the physician feels awkward about examining this area and fails to do so, the lobes are not correctly evaluated, and any corresponding abnormalities are not heard.
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Causes

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  • Obstruction of an airway or diminished distention of alveoli may cause atelectasis.
  • The most common causes involving airway obstruction include the following:
    • Airway obstruction due to a mucous plug or other airway secretions, such as with bronchiolitis
    • Bronchospasm airway secretions and airway inflammation in patients with asthma
    • Abnormal airway secretions in cystic fibrosis
    • Abnormal airway clearance, such as with ciliary dyskinesia syndrome
    • Airway foreign body
    • Extrinsic compression on an airway (eg, compression due to an enlarged or aberrant vessel)
    • Enlarged lymph nodes that compress the airway
    • Masses in the chest that compress the airway or alveoli
    • Cardiomegaly or enlarged pulmonary vessels that compress adjacent airways
  • Causes of diminished alveolar distention include the following:
    • Small or dysmorphic chest wall
    • Severe scoliosis
    • Neuromuscular diseases
    • Anesthesia or sedation
    • Pain from upper abdominal surgery
    • Abdominal distention
    • Chest wall or upper abdominal pain
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Contributor Information and Disclosures
Author

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

References
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  2. Engoren M. Lack of association between atelectasis and fever. Chest. 1995 Jan. 107(1):81-4. [Medline].

  3. Raman TS, Mathew S, Ravikumar, Garcha PS. Atelectasis in children. Indian Pediatr. 1998 May. 35(5):429-35. [Medline].

  4. Liu J, Chen SW, Liu F, Li QP, Kong XY, Feng ZC. The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest. 2015 Apr. 147 (4):1013-9. [Medline].

  5. Bilan N, Galehgolab BA, Shoaran M. Medical treatment of lung collapse in children. Pak J Biol Sci. 2009 Mar 1. 12(5):467-9. [Medline].

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  13. Miske LJ, Hickey EM, Kolb SM, et al. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004 Apr. 125(4):1406-12. [Medline].

  14. Schindler MB. Treatment of atelectasis: where is the evidence?. Crit Care. 2005 Aug. 9(4):341-2. [Medline].

  15. Slattery DM, Waltz DA, Denham B, et al. Bronchoscopically administered recombinant human DNase for lobar atelectasis in cystic fibrosis. Pediatr Pulmonol. 2001 May. 31(5):383-8. [Medline].

  16. Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000 Dec. 118(6):1801-13. [Medline].

  17. Woodring JH. Determining the cause of pulmonary atelectasis: a comparison of plain radiography and CT. AJR Am J Roentgenol. 1988 Apr. 150(4):757-63. [Medline].

  18. Wu KH, Lin CF, Huang CJ, Chen CC. Rigid ventilation bronchoscopy under general anesthesia for treatment of pediatric pulmonary atelectasis caused by pneumonia: A review of 33 cases. Int Surg. 2006 Sep-Oct. 91(5):291-4. [Medline].

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Atelectasis. Left lower lobe collapse. The opacity is in the posterior inferior location.
 
 
 
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