Atelectasis is what? Diagnosis, treatment and prognosis

Atelectasis is what? The answer to this medical question is known only to experienced specialists. But to clarify it you do not need a doctor. Details on atelectasis you can find out from the materials of the article in question.

Definition of term

Atelectasis is a pathological condition characterized by a loss of airiness by all of the lungs or by its specific site. The term in question is of Greek origin. In translation into Russian it means "failed" or "incomplete stretching of the tissue".

Causes of development

Atelectasis is the fall of the lung segment. Several factors can lead to the development of such a pathological condition. Let's list the main ones right now:

• An increase in the surface tension observed on the walls of the alveoli. Typically, this pathology is caused by pulmonary edema of non-cardiogenic or cardiogenic origin, as well as a lack of surfactant or infectious processes.
• Compression of the airways or lungs, which is due to various external factors (for example, mediastinal tumor, anomaly in the development of large blood vessels, lymphadenopathy, myocardial hypertrophy , etc.).
• Pathology of the mucosa (inner) walls of the bronchus (for example, bronchomalacia, deformity, swelling or edema).
• Obstruction or so-called obstruction of bronchial lumen by foreign bodies, mucus, caseous masses (for example, in case of tuberculosis), as well as swelling of the mucous membrane.
• Violations of natural chest excursions that arise from paralysis of the diaphragmatic nerve, general anesthesia, scoliosis or neuromuscular diseases.
• Increase in internal pressure in the pleural cavity (including hemothorax, hydrothorax, empyema, pneumothorax).

Why else can atelectasis arise? The causes of this condition often hide in the acute massive collapse of the lung, which occurs as a postoperative complication due to the patient's continued immobility, an overdose of oxygen, hypothermia, the use of large doses of sedatives and opiates, and vasodilating drugs.

Risk factors

Who most often has atelectasis? This disease is inherent in people with obesity, cystic fibrosis and bronchial asthma. He is also susceptible to heavy smokers.

Classification

By origin, atelectasis of the lobe of the lung can be congenital (that is, primary) or acquired (ie, secondary).

By primary disease is meant a condition where a newborn baby does not have lung spreading. With regard to acquired atelectasis, in this case there is a decrease in lung tissue, which previously participated in the process of breathing.

It should be said that such phenomena should be distinguished from intrauterine atelectasis, that is, the airless state of the lungs, which is observed in the fetus, and physiological (that is, hypoventilation, which appears in quite healthy people and is a kind of functional reserve of lung tissue).

Types of disease

Depending on the volume of lung tissue that leaves the respiration process, the disease under consideration is divided into:

• Acinous;
• Segmented;
• Lobular;
• Total;
• Share.

It can also be two-sided or one-sided. By the way, the first variety is extremely dangerous and can easily lead to the death of the patient.

Types of the disease

Depending on the etiopathogenetic factors, the pathology of the pulmonary system under consideration is divided into the following types:

• Compression atelectasis, or collapse, of the lung. This condition is caused by the compression of the pulmonary tissues from the outside, and by the accumulation in the pleural cavity of exudate, air, blood or pus.
• Obturation atelectasis. This phenomenon is associated with a mechanical violation of the patency of the trachea and bronchi.
• Diskovidny atelectasis of the lung. This pathology usually develops after a chest concussion or fracture of the ribs.
• Contractile - is caused by compression of the alveoli by fibrous tissue (in the subpleural parts of the lungs).
• Acinar - is associated with a lack of surfactant (most often occurs in adults and newborns with respiratory distress syndrome).

It should also be noted that the disease in question can be reflex and postoperative, developing gradually and acutely, uncomplicated and complicated, transient and persistent.

Symptoms

The severity of the lung atelectasis clinic depends on the volume of nonfunctioning and the rate of lung tissue loss. Micro-telecases, single segmental atelectasis and middle-average syndrome very often occur asymptomatically.

As for the acute disease, it has a marked symptomatology. In this case, the patient feels sudden pain, paroxysmal dyspnea, cyanosis, dry cough, tachycardia and arterial hypotension. With a sudden increase in respiratory insufficiency, even a lethal outcome may occur.

When examining the patient, lagging of the affected lung lobe during respiration is revealed, as well as a decrease in the chest respiratory tract. In addition, blunt percutaneous or shortened sound is defined above the focus of atelectasis. At the same time, breathing is greatly weakened (may not be audible).

Complications of atelectasis

With the gradual switching off of the segments of the lungs from ventilation, the symptoms of the disease are expressed to a lesser degree. But later in the field of hypopneumosis, atelectatic pneumonia develops.

The appearance of a cough with phlegm, an increase in body temperature, as well as an increase in symptoms of intoxication indicate the attachment of inflammation. In this case, the disease in question is complicated by the development of a lung abscess or abscessed pneumonia.

Diagnostics

Diagnosis of lung atelectasis is carried out by means of radiological examination of the respiratory organ in lateral and direct projections. This reveals a homogeneous darkening of the pulmonary field, as well as a shift in the mediastinum towards the fraction that has fallen out of the respiration process. In addition, the x-ray shows a high position of the dome of the diaphragm and increased airiness of the lung.

In doubtful cases, this method of investigation is refined by CT. Also, to determine the causes of obstructive atelectasis, bronchoscopy is used, and with prolonged atelectasis, angiopulmonography and bronchography are performed.

Treatment

Detection of atelectasis of the lung requires from the doctor (pulmonologist, neonatologist, traumatologist or thoracic surgeon) active tactics. Newly born babies with primary atelectasis of the lung produce sucking of the contents of the respiratory organs by means of a rubber catheter. If required, intubation of the trachea and dilatation of the lung are performed.

With this type of disease, as obstructive atelectasis, which was caused by a foreign body, it is extracted by means of medical diagnostic bronchoscopy.

If the recession of the lung was caused by a clump of difficult secret, then endoscopic sanitation of the bronchial tree is performed.

To eliminate postoperative atelectasis, tracheal aspiration, respiratory gymnastics, percussion chest massage, postural drainage, as well as inhalations with enzyme and bronchodilator drugs are performed.

It should also be said that with atelectasis of the lungs of any origin, mandatory implementation of preventive anti-inflammatory therapy is required.

Forecast

Success in the spread of the lung depends on the timing of the initiation of treatment and the cause of atelectasis. With the complete elimination of the latter in the first three days, the prognosis regarding the restoration of the respiratory tract site is favorable.

In case of neglected cases, it is impossible to exclude the development of secondary changes in the collapsed share. Rapidly developed and massive atelectasis can lead to death.