Atelectasis

What Is Atelectasis?

Atelectasis is a lung condition that happens when your airways or the tiny sacs at the end of them don’t expand the way they should when you breathe.

Your lungs are where your body takes in oxygen and gets rid of carbon dioxide. When you breathe in, air flows into your windpipe, or trachea. The trachea splits into two channels called bronchi, and each bronchus goes to a lung.

Inside your lungs, those airways divide again and again into smaller tubes called bronchioles. At the end of the smallest bronchioles are tiny sacs called alveoli. Here, your blood dumps carbon dioxide and picks up fresh oxygen to carry to the cells in your body.

When you breathe in and out, your lungs inflate and deflate like balloons. But if your airways get blocked or something puts pressure on your lungs, they might not inflate the way they should. Doctors call that condition atelectasis. It can be life-threatening in small children or people who have another lung problem.

Atelectasis Symptoms

If you have atelectasis, you'll feel like you can’t get enough air. Other symptoms can include:

If you’re having trouble breathing, get medical help right away.

Causes of Atelectasis

It’s common to get atelectasis after you have surgery. The medication that puts you to sleep (called anesthesia) can affect how your lungs work. The surgery itself could also make it hurt to breathe deeply.

You may get atelectasis when your airways are physically blocked by something like:

  • Mucus
  • An object that you accidentally inhaled
  • A tumor in your airway

Or you might get it because of outside pressure. This can be caused by:

  • A tumor pressing on your airway
  • A deformed bone
  • A tight brace or body cast
  • Fluid or air between your lung and your chest wall (pleural effusion and pneumothorax)
  • Pneumonia
  • Scarred lung tissue

Risk Factors for Atelectasis

Some people may be more likely than others to have atelectasis. Things that can raise your chances of it include:

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Types of Atelectasis

The two main types of atelectasis are obstructive (also called resorptive) and nonobstructive.

Obstructive atelectasis happens when something physically blocks your airway.

Types of nonobstructive atelectasis include:

  • Relaxation or compressive. The lining of your chest wall and the surface of your lungs are usually in close contact, keeping your lungs expanded. But if fluid or air builds up and separates them, your lungs can pull inward, and your alveoli can lose air. Depending on where this happens in your lung, it's either relaxation or compressive atelectasis.
  • Adhesive. The fluid that lines the alveoli in your lungs has a material in it called pulmonary surfactant. It helps your lungs in several ways, including keeping the alveoli stable and able to work. If there's a problem with this material (like if your body doesn’t make enough of it), the alveoli can collapse. When that happens, it's called adhesive atelectasis. It can be caused by serious lung problems such as respiratory distress syndrome or a bruised lung (pulmonary contusion).
  • Cicatricial. This type of atelectasis is when the tissue that makes up your lungs has scars that keep them from being able to hold as much air as they should. This scarring can happen because of certain serious lung conditions like sarcoidosis.
  • Replacement. This is when your alveoli are filled by a tumor. That causes an area of your lung to collapse.
  • Acceleration. When jet pilots fly straight up really fast (between 5 and 9 G-forces), the acceleration can close the airways in their lungs, leading to this type of atelectasis. It can make it hard to breathe and cause chest pain and coughing.
  • Rounded (also called folded lung). This type is linked to pleural diseases, conditions that affect the thin tissue that lines your chest cavity and surrounds your lungs (the pleura). One of the most common causes is asbestosis, when you breathe in asbestos over a long period of time and this damages the pleura.

Atelectasis Diagnosis

If your doctor thinks you might have atelectasis, they'll probably recommend tests such as:

  • A chest X-ray. A collapsed lung may look partly or completely white on the image.
  • CT scans. These give a more detailed picture of your lungs.
  • Ultrasound. This uses sound waves to make images of your airways. It can tell your doctor more about what’s causing your symptoms.
  • Bronchoscopy. Your doctor uses a device called a bronchoscope to look inside your lungs and find the problem. A bronchoscope is a thin tube with a light and a camera that goes down your throat and into your airways.
  • Oximetry or blood gas test. These measure how much oxygen is getting into your blood.

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Atelectasis Treatment and Recovery

If a tumor or another health condition is causing the problem, your doctor will treat it.

Atelectasis treatments include:

  • Bronchoscopy to clear blockages like mucus
  • Medicine that you breathe in through an inhaler
  • Physiotherapy such as tapping on your chest to break up mucus, lying on one side or with your head lower than your chest to drain mucus, and exercises to help you breathe better
  • A breathing tube or continuous positive airway pressure (CPAP) machine

Complications of Atelectasis

If atelectasis isn’t treated, it can have complications including:

  • Pneumonia. Mucus can cause an infection in your lung.
  • Respiratory failure
  • Fluid buildup
  • Low blood oxygen. If your lungs can’t inflate right, they might not be able to get enough oxygen into your blood.

Atelectasis Prevention

Some steps may help prevent atelectasis:

  • Ask your doctor about deep breathing exercises and coughing after you have surgery.
  • Also talk to them about a device called an incentive spirometer, which helps promote proper breathing.
  • Quit smoking, ideally at least 6 to 8 weeks before having any kind of operation.

Atelectasis Outlook

Your outlook depends on several things, including the cause of your atelectasis. After treatment, a collapsed lung usually begins working the way it should again. But atelectasis can cause permanent damage in some cases.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on June 21, 2020

Sources

SOURCES:

National Heart, Lung, and Blood Institute: “Atelectasis,” “Bronchoscopy.”

Johns Hopkins Medicine: “Atelectasis.”

Continuing Education in Anaesthesia Critical Care & Pain: “Pulmonary atelectasis in anaesthesia and critical care.”

Cleveland Clinic: “Atelectasis.”

Mayo Clinic: “Atelectasis.”

Medscape: “Atelectasis.”

Merck Manual Consumer Version: “Atelectasis.”

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