Atelectasis Clinical Presentation
- Author: Tarun Madappa, MD, MPH; Chief Editor: Ryland P Byrd, Jr, MD more...
Atelectasis may occur postoperatively following thoracic or upper abdominal procedures.
Although atelectasis is considered to be the most common cause of early postoperative fever, the existing evidence is contradictory. In a study by Mavros et al, they found no clinical evidence supporting the concept that atelectasis is associated with early postoperative fever.
Most symptoms and signs are determined by the rapidity with which the bronchial occlusion occurs, the size of the lung area affected, and the presence or absence of complicating infection.
Rapid bronchial occlusion with a large area of lung collapse causes pain on the affected side, sudden onset of dyspnea, and cyanosis. Hypotension, tachycardia, fever, and shock may also occur.
Slowly developing atelectasis may be asymptomatic or may cause only minor symptoms. Middle lobe syndrome often is asymptomatic, although irritation in the right middle and right lower lobe bronchi may cause a severe, hacking, nonproductive cough.
The physical examination findings may demonstrate dullness to percussion over the involved area and diminished or absent breath sounds. Chest excursion of the involved hemithorax may be reduced or absent. The trachea and the heart may be deviated toward the affected side.
The primary cause of acute or chronic atelectasis is bronchial obstruction by the following:
Plugs of tenacious sputum
Tumors, a lymph node, or an aneurysm compressing the bronchi and bronchial distortion
External pulmonary compression by pleural fluid or air (ie, pleural effusion, pneumothorax) may also cause atelectasis.
Abnormalities of surfactant production contribute to alveolar instability and may result in atelectasis. These abnormalities commonly occur with oxygen toxicity and ARDS.
Resorptive atelectasis is caused by the following:
Bronchial obstruction from metastatic neoplasm (eg, adenocarcinoma of breast or thyroid, hypernephroma, melanoma)
Inflammatory etiology (eg, tuberculosis, fungal infection)
Aspirated foreign body
Malpositioned endotracheal tube
Extrinsic compression of an airway by neoplasm, lymphadenopathy, aortic aneurysm, or cardiac enlargement
Relaxation atelectasis is caused by the following:
A large emphysematous bulla
Compression atelectasis is caused by the following:
Chest wall, pleural, or intraparenchymal masses
Loculated collections of pleural fluid
Adhesive atelectasis is caused by the following:
Hyaline membrane disease
Acute respiratory distress syndrome
Cardiac bypass surgery
Prolonged shallow breathing
Cicatrization atelectasis is caused by the following:
Idiopathic pulmonary fibrosis
Replacement atelectasis is caused by alveoli filled by tumor or fluid.
Right middle lobe syndrome (also known as Brock syndrome) refers to recurrent right middle lobe collapse secondary to airway disease, infection, or a combination of the two. The right middle lobe bronchus is long and thin, has the poorest drainage or clearance of all the lobes of the lung, which can result in retained mucus, and is more prone to extrinsic compression by the lymphatic system. Individuals with middle lobe syndrome are often asymptomatic, although some present with recurrent productive cough and history of right-sided pneumonias.
Rounded atelectasis is caused primarily by asbestos-related pleural disease and uremic pleuritis.
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