Cicatrisation Atelectasis – Causes, Symptoms & Treatment
Cicatrisation atelectasis is a form of lung collapse caused by fibrous scar tissue that contracts and permanently closes off air spaces in the lung. It results from fibrotic remodeling of the lung tissue.
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Cicatrisation atelectasis is a form of lung collapse caused by fibrous scar tissue that contracts and permanently closes off air spaces in the lung. It results from fibrotic remodeling of the lung tissue.
What is Cicatrisation Atelectasis?
Cicatrisation atelectasis (also called contraction atelectasis) is a specific type of atelectasis – a collapse of part of the lung – in which fibrous scar tissue mechanically contracts the affected lung segments, preventing them from filling with air. Unlike other forms of atelectasis, this process is generally irreversible, as the normal lung architecture is replaced by non-functional fibrous tissue.
Causes
Cicatrisation atelectasis develops as a result of pulmonary fibrosis, which may stem from a variety of underlying conditions:
- Pulmonary tuberculosis: One of the most common causes; healed infection leaves extensive scar tissue.
- Idiopathic pulmonary fibrosis (IPF): A chronic, progressive lung disease of unknown origin.
- Sarcoidosis: An inflammatory disease that can cause granuloma formation and fibrosis in the lungs.
- Radiation fibrosis: Scarring following radiotherapy to the chest area.
- Chronic inflammation: Such as recurrent pneumonia or autoimmune diseases like rheumatoid arthritis.
- Pneumoconioses: Occupational dust-related lung diseases such as silicosis or asbestosis.
Symptoms
Symptoms depend on the extent of the affected lung area and the severity of the underlying fibrosis. Common symptoms include:
- Shortness of breath (dyspnoea): Initially on exertion, later at rest in advanced stages
- Chronic cough, often dry or with little sputum
- Reduced breath sounds over the affected lung regions
- Low blood oxygen levels (hypoxaemia) in extensive disease
- Cyanosis: Bluish discolouration of the lips or fingernails in severe cases
- Reduced physical exercise capacity
Diagnosis
Diagnosis is typically established through imaging and pulmonary function testing:
- Chest X-ray: Typically reveals opacification, volume loss, and structural displacement (e.g., mediastinal shift).
- High-resolution CT (HRCT) of the chest: The gold standard for assessing the extent, distribution, and underlying cause of the fibrosis.
- Pulmonary function tests (spirometry/body plethysmography): Show a restrictive ventilatory pattern with reduced total lung capacity.
- Arterial blood gas analysis: To detect any associated oxygen deficiency.
- Bronchoscopy: When an endobronchial cause is suspected or tissue sampling is needed.
Treatment
Because cicatrisation atelectasis is based on irreversible fibrosis, treatment focuses primarily on managing the underlying condition and relieving symptoms:
Treatment of the Underlying Disease
- Antibiotic or antituberculous therapy for infectious causes
- Antifibrotic medications (e.g., pirfenidone, nintedanib) for idiopathic pulmonary fibrosis
- Immunosuppressive therapy for autoimmune diseases or sarcoidosis
Symptomatic and Supportive Care
- Supplemental oxygen therapy for confirmed hypoxaemia
- Pulmonary rehabilitation: Breathing physiotherapy and exercise training to improve functional capacity
- Treatment of secondary infections with targeted antibiotic therapy
- In selected severe cases, lung transplantation may be considered
Distinction from Other Types of Atelectasis
Cicatrisation atelectasis differs from other forms such as resorption atelectasis (caused by bronchial obstruction), compression atelectasis (caused by external pressure, e.g., pleural effusion), or relaxation atelectasis (caused by pneumothorax). It is the only form in which the underlying change – fibrosis – directly causes collapse through tissue shrinkage and is generally not reversible.
References
- Travis, W. D. et al. – An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. American Journal of Respiratory and Critical Care Medicine, 2011; 183(6):788–824.
- Franquet, T. – Imaging of Pulmonary Viral Pneumonia. Radiology, 2011; 260(1):18–39. PubMed PMID: 21697307.
- Webb, W. R. / Muller, N. L. / Naidich, D. P. – High-Resolution CT of the Lung. 5th edition. Lippincott Williams and Wilkins, 2014.
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