History
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. [6]
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.
Physical Examination
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.
Complications
Complications may include the following:
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Acute pneumonia
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Hypoxemia and respiratory failure
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Postobstructive drowning of the lung
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Sepsis
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Pleural effusion and empyema
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Atelectasis. Left lower lobe collapse. The opacity is in the posterior inferior location.
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Atelectasis. Loss of volume on the left side; an elevated and silhouetted left diaphragm; and an opacity behind the heart, called a sail sign, are present.
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Atelectasis. Left upper lobe collapse showing opacity contiguous to the aortic knob, a smaller left hemithorax, and a mediastinal shift.
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Atelectasis. CT scan of a left upper lobe collapse with a small pleural effusion.
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Complete atelectasis of the left lung. Mediastinal displacement, opacification, and loss of volume are present in the left hemithorax.
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Atelectasis. Right lower lobe collapse.
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Atelectasis. Both right lower lobe and right middle lobe collapse. The left lung is hyperexpanded.
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Complete right lung atelectasis.
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Atelectasis. A lateral chest x-ray film confirms the diagnosis of right middle lobe collapse. The minor fissure moves down, and the major fissure moves up, leading to a wedge-shaped opacity.
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Atelectasis. The left upper lobe collapses anteriorly on a lateral chest x-ray film.
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Atelectasis. Left upper lobe collapse. The top of the aortic knob sign is demonstrated.
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Atelectasis. Left lower lobe collapse.
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Atelectasis. Right middle lobe collapse shows obliteration of the right heart border.
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Atelectasis. The azygous lobe of the right lung may be mistaken for a collapsed right upper lobe.
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Atelectasis. Left lower lobe collapse. The sail sign is obvious.
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Atelectasis. Left upper lobe collapse. The Luft Sichel sign is demonstrated clearly in this radiograph.
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Atelectasis. Chest CT scan showing left upper lobe collapse.
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Atelectasis. The right lower lobe collapses inferiorly and posteriorly.
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Atelectasis. Right lower lobe collapse without middle lobe collapse, the right major fissure is shifted downward and is now visible.
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Atelectasis. Right middle lobe collapse showing obliteration of the right heart border.
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Atelectasis. Right middle lobe collapse on a lateral chest x-ray film.
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Atelectasis. Right upper lobe collapse and consolidation.
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Atelectasis. Right upper lobe collapse.
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Atelectasis. Left lower lobe collapse on posteroanterior view.
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The left lower lobe collapses toward the posterior and inferior aspects of the thoracic cavity; the atelectatic left lower lobe is present as a sail behind the cardiac shadow.
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Atelectasis. Chest posteroanterior radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
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Atelectasis. Chest lateral radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
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Atelectasis. CT scan of the chest shows tumor encasing and occluding the right upper lobe bronchus and collapse of the right upper lobe, with superior and medial displacement of the minor fissure.
