Atelectasis

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Definition

-  Diminished lung volume effecting all or part of a lung (incomplete expansion)

 

Features

-  Very common CXR finding

-  Obstructive

-  Most common

-  Reabsorption of gas when airway obstructed

-  Vary in size by airway effected: segmental or lobar

-  Nonobstructive

-  Right Middle Lobe Syndrome

-  Recurrent or fixed atelectasis of right middle lobe +/- lingula

-  Obstructive or non

-  May lead to bronchiectasis

-  May be caused by Sjogrens syndrome

-  Rounded Atelectasis

-  Folded lung tissue w fibrous bands & adhesions

-  High rate in asbestos workers (65-70% pts)

-  Typically asymptomatic

 

Causes

-  Obstructive

-  Foreign body

-  Inc malpositioned ET tube during GA

-  Endobronchial tumour

-  Mucous plug

-  Nonobstructive

-  Relaxation/passive

-  Seperation of parietal & visceral pleura

-  Pleural Effussion or pneumothorax

-  Compression

-  Space occupying lesion

-  Adhesive

-  Loss of surfactant

-  ARDS, O2 toxicity

-  Cicatrisation

-  Loss of parenchyma

-  Granulomatous disease (TB)

-  Scarring, infiltration

-  Post-op

-  Common complicaton of thoracic or upper abdo Surgery

-  Most common cause of post-op fever on Day 1

-  Cause by GA & manipulation --> diaphragm dysfuction & diminished surfactant activity

-  Usually basilar & segmental

 

Associated S/S

-  Rapid occlusion

-  Dyspnoea, cyanosis

-  Hypotension, tachycardia, shock

-  Fever

-  Slow development +/- asymptomatic

-  Chest Exam

-  Dullness to percusiion

-  Diminished/absent breath sounds

-  Reduced chest excursion

-  Mediastinal deviation to affected side

 

Ix

-  CXR

-  Fissures & opacification of collapsed lobe

-  Loss of volume on ipsilateral hemithorax

-  Elevated diaphragm

-  Rib crowding

-  Mediastinal deviation to affected side

-  Hyperlucency of remaining lobes

-  By Lobes

-  RUL

-   Moves med & sup --> elevated right hilum & minor fissure

-  RML

-   Right heart border obscured, +/- triangular opacity

-  RLL

-   Moves post & inf, triangular opacity, major fissure visible

-   Superior triangle sign

-   +/- elevated right hemidiaphragm

-   +/- heart shifted to right

-  LUL

-   Moves ant & sup, crescent of lung

-  LLL

-   Retrocardiac opacity, left hilum moves down

-  Complete collapse

-  Opacification of entire hemithorax

-  Ipsitaleral mediastinal shift

-   DDx massive pleural effusion by midline shift

 

 

-  O2Sat: hypoxia

-  ABGs: hypoxaemia but normal to low CO2 due to increased V/Q

 

Mx

-  Chest physio: huffing, percussion/vibration

-  Postural drainage

-  Bronchoscopy

-  Post op

-  Supplemental O2 therapy: sats >90%

-  +/- CPAP

-  Careful use of opiates

-  Cough supression if too much

-  Adequate to allow deep respiration

-  Early ambulation

-  Incentive spirometry, chest physio

-  Deep breaths & coughing

-  Place pt on unaffected side

-  Bronchoscopy if refractory

-  Sputum MCS --> Abx