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Atelectasis

Overview

Atelectasis (at-uh-LEK-tuh-sis) is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid.

Atelectasis is one of the most common breathing (respiratory) complications after surgery. It's also a possible complication of other respiratory problems, including cystic fibrosis, lung tumors, chest injuries, fluid in the lung and respiratory weakness. You may develop atelectasis if you breathe in a foreign object.

Atelectasis can make breathing difficult, particularly if you already have lung disease. Treatment depends on the cause and severity of the collapse.

SYMPTOMS AND CAUSES

If atelectasis affects only a small area of the lungs, you may not have any symptoms. But if it affects larger areas, the lungs cannot fill with enough air, and the oxygen level in your blood may go down. When this happens, uncomfortable symptoms can occur, including:

  • Trouble breathing (shortness of breath)
  • Increased heart rate
  • Coughing
  • Chest pain
  • Skin and lips turning blue

Other conditions including asthma and emphysema can also cause chest pain and trouble breathing. If you experience these symptoms, you should see your doctor for the correct diagnosis and treatment.

Atelectasis has many causes. Any condition that makes it hard to take deep breaths or cough can lead to a collapse in the lung.

People may call atelectasis or other conditions a “collapsed lung.” Another condition that commonly causes a collapsed lung is pneumothorax. Pneumothorax is the presence of air between the lung and the chest wall, which can cause the lung to collapse.

Causes

Surgery: Surgery is the most common reason people develop atelectasis. Medicine to keep you asleep during surgery (anesthesia) can affect your ability to breathe normally or cough. Pain after surgery could make deep breaths painful. Continued shallow breathing because of the pain can lead to deflated air sacs.

Chest pressure: Pressure from outside the lungs can make deep breathing difficult. This type of pressure can come from a tumor or other growth, a deformed bone, or a tight brace or body cast. If the cause of the pressure is not clear, your doctor will do additional tests to identify its source.

Blocked airway: A blocked airway can also cause atelectasis. If air cannot get past the blockage, the affected part of the lung could collapse. Mucus or an inhaled object could cause a blockage.

Other lung conditions: Other medical conditions involving the lungs can also be associated with atelectasis. These disorders could include lung cancer, pneumonia, pleural effusions (fluid around the lungs) and respiratory distress syndrome (RDS).

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.

DIAGNOSIS AND TESTS

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.

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