Atelectasis: Causes, Symptoms and Treatment
Atelectasis is a condition in which part of the lung collapses and is no longer filled with air, impairing gas exchange and potentially causing shortness of breath.
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Atelectasis is a condition in which part of the lung collapses and is no longer filled with air, impairing gas exchange and potentially causing shortness of breath.
What is Atelectasis?
Atelectasis refers to the complete or partial collapse of a section of the lung, in which the alveoli (tiny air sacs) are no longer filled with air. The term comes from Greek: ateles (incomplete) and ektasis (expansion). Because the affected areas of the lung can no longer perform gas exchange, blood oxygen levels may fall significantly.
Causes
Atelectasis can develop through several different mechanisms:
- Obstructive atelectasis: A foreign body, mucus plug, or tumor blocks the airway, causing the air behind the obstruction to be reabsorbed and the lung segment to collapse.
- Compressive atelectasis: Fluid (pleural effusion), air (pneumothorax), or an enlarged structure in the chest cavity presses on lung tissue from outside, preventing it from expanding.
- Relaxation atelectasis: Loss of normal lung tension, for example after surgery or during prolonged bed rest, prevents full expansion of the alveoli.
- Cicatricial (fibrotic) atelectasis: Scarring of lung tissue prevents full expansion.
- Surfactant deficiency: Particularly in premature infants, a lack of the surfactant film that keeps alveoli open leads to what is known as respiratory distress syndrome.
Symptoms
The symptoms of atelectasis depend on the size of the affected area and how quickly it develops:
- Shortness of breath (dyspnea)
- Rapid, shallow breathing (tachypnea)
- Cough
- Chest pain on the affected side
- Bluish discoloration of the lips or fingernails (cyanosis) in severe oxygen deficiency
- Rapid heart rate (tachycardia)
Small areas of atelectasis are often asymptomatic and are discovered incidentally during chest imaging.
Diagnosis
Several methods are used to diagnose atelectasis:
- Chest X-ray: Typically shows increased density (opacity) in the affected lung region and may reveal displacement of structures such as the heart or diaphragm.
- Computed tomography (CT scan): Provides a more detailed view and helps identify the underlying cause.
- Bronchoscopy: Allows direct inspection of the airways and, if necessary, removal of obstructions.
- Pulse oximetry and blood gas analysis: Measure blood oxygen levels and can indicate impaired gas exchange.
Treatment
Treatment depends on the underlying cause and extent of the atelectasis:
- Physiotherapy and breathing exercises: Deep breathing, incentive spirometry (use of a breathing training device), and positioning maneuvers help re-expand collapsed lung segments. This is especially important after surgery.
- Suctioning and bronchoscopy: If the airway is blocked by mucus or a foreign body, bronchoscopic removal may be necessary.
- Treatment of the underlying condition: Pleural effusions or pneumothorax are drained; tumors may be treated surgically, with radiation, or with medication.
- Oxygen therapy: Supplemental oxygen is provided when blood oxygen levels are low.
- Ventilatory support: In severe cases, mechanical ventilation with positive end-expiratory pressure (PEEP) may be required to keep the alveoli open.
Prevention
In many cases, atelectasis can be prevented or its extent reduced:
- Regular deep breathing exercises, especially after surgery or during bed rest
- Early mobilization following medical procedures
- Adequate pain management that allows deep breathing
- Avoiding smoking, as it increases mucus production and damages cilia in the airways
References
- Kasper, D. L. et al. - Harrison's Principles of Internal Medicine, 21st Edition. McGraw-Hill Education, 2022.
- Mason, R. J. et al. - Murray and Nadel's Textbook of Respiratory Medicine, 7th Edition. Elsevier, 2021.
- World Health Organization (WHO) - Respiratory Diseases Overview. Available at: https://www.who.int/health-topics/chronic-respiratory-diseases
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