What does the diagnosis of atelectasis of the left upper lobe mean? What is atelectasis of a lobe or the whole lung? How does a child breathe?

Atelectasis - what is it? The answer to this medical question is known only to experienced specialists. But you don't need a doctor to find out. You can learn more about atelectasis from the materials in this article.

Definition of the term

Atelectasis is a pathological condition characterized by loss of airiness in the entire lung or a specific area of ​​it. The term in question is of Greek origin. Translated into Russian, it means “failed” or “incomplete stretching of the tissue.”

Reasons for development

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

• Enlargement observed on the walls of the alveoli. As a rule, 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 lung, which is caused by various external factors (for example, a tumor of the mediastinum, an anomaly in the development of large blood vessels, lymphadenopathy, etc.).
• Pathology of the mucous membrane (inner) of the bronchial wall (for example, bronchomalacia, deformation, tumor or edema).
• Obstruction or so-called blockage of the bronchial lumen by foreign bodies, mucus, caseous masses (for example, with tuberculosis), as well as swelling of the mucous membrane.
• Disturbances in natural chest excursion that occur due to phrenic nerve palsy, general anesthesia, scoliosis, or neuromuscular diseases.
• Increased internal pressure in the pleural cavity (including with hemothorax, hydrothorax, empyema, pneumothorax).

Why else can atelectasis occur? The causes of this condition are often hidden in acute massive collapse of the lung, which occurs as a postoperative complication due to prolonged immobility of the patient, oxygen overdose, hypothermia, the use of large dosages of sedatives and opiates, as well as vasodilators.

Risk factors

Who is most likely to experience atelectasis? This disease is common in people with obesity, cystic fibrosis and bronchial asthma. Heavy smokers are also susceptible to it.

Classification

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

By primary disease we mean a condition when a newborn baby’s lung does not expand. As for acquired atelectasis, in this case there is a collapse of the lung tissue, which was previously involved in the breathing process.

It must be said that such phenomena should be distinguished from intrauterine atelectasis, that is, the airless state of the lungs that is observed in the fetus, and physiological (that is, hypoventilation that occurs in completely healthy people and represents a certain functional reserve of the lung tissue).

Types of disease

Depending on the volume of lung tissue that emerges from the breathing process, the disease in question is divided into:

• acinous;
• segmental;
• lobular;
• total;
• shared

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

Types of disease

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

• Compression atelectasis, or collapse, of the lung. This condition is caused by compression of the lung tissue from the outside, as well as the accumulation of exudate, air, blood or pus in the pleural cavity.
• Obstructive atelectasis. This phenomenon is associated with a mechanical violation of the patency of the trachea and bronchi.
• Discoid atelectasis of the lung. This pathology usually develops after a chest contusion or rib fracture.
• Contraction - caused by compression of the alveoli by fibrous tissue (in the subpleural parts of the lungs).
• Acinar - 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 reflexive and postoperative, developing gradually and acutely, uncomplicated and complicated, transient and persistent.

Symptoms

The severity of pulmonary atelectasis depends on the volume of non-functioning and the rate of collapse of lung tissue. Microatelectasis, single segmental atelectasis and middle lobe syndrome are very often asymptomatic.

As for the acutely developed disease, it has severe symptoms. In this case, the patient feels sudden pain, paroxysmal shortness of breath, cyanosis, dry cough, tachycardia and arterial hypotension. With a sharp increase in respiratory failure, even death can occur.

When examining the patient, a lag in the affected lobe of the lung during breathing is revealed, as well as a decrease in the respiratory excursion of the chest. In addition, a dull percussion or shortened sound is detected above the focus of atelectasis. In this case, breathing sharply weakens (may not be audible).

Complications of atelectasis

With the gradual switching off of lung segments from ventilation, the signs of the disease are expressed to a lesser extent. But subsequently, atelectatic pneumonia develops in the area of ​​hypopneumatosis.

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

Diagnostics

Diagnosis of pulmonary atelectasis is carried out through the respiratory organ in the lateral and direct projections. This reveals a homogeneous darkening of the pulmonary field, as well as a shift of the mediastinum towards the lobe that has fallen out of the breathing 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 research is clarified using CT. Also, to determine the causes of the development of obstructive atelectasis, bronchoscopy is used, and with prolonged atelectasis, angiopulmonography and bronchography are performed.

Treatment

Detection of pulmonary atelectasis requires active tactics from the doctor (pulmonologist, neonatologist, traumatologist or thoracic surgeon). Newly born babies with primary atelectasis of the lung undergo suction of the contents of the respiratory organs using a rubber catheter. If required, tracheal intubation and lung expansion are performed.

With a type of disease such as obstructive atelectasis, which was caused by a foreign body, it is removed through therapeutic and diagnostic bronchoscopy.

If the collapse of the lung was caused by the accumulation of difficult-to-remove secretions, then endoscopic sanitation of the bronchial tree is performed.

In order to eliminate postoperative atelectasis, tracheal aspiration, breathing exercises, percussion chest massage, as well as inhalation with enzyme and bronchodilator drugs are performed.

It should also be said that for pulmonary atelectasis of any origin, preventive anti-inflammatory therapy is required.

Forecast

Success in expanding the lung depends on the timing of treatment and the cause of atelectasis. If the latter is completely eliminated in the first three days, the prognosis for restoration of the respiratory organ area is favorable.

In advanced cases, the development of secondary changes in the collapsed lobe cannot be ruled out. Rapidly developed and massive atelectasis can lead to death.

– airlessness of the lung tissue, caused by the collapse of the alveoli in a limited area (in a segment, lobe) or in the entire lung. In this case, the affected lung tissue is excluded from gas exchange, which may be accompanied by signs of respiratory failure: shortness of breath, chest pain, cyanotic discoloration of the skin. The presence of atelectasis is determined by auscultation, radiography and CT scan of the lung. To straighten the lung, therapeutic bronchoscopy, exercise therapy, chest massage, and anti-inflammatory therapy may be prescribed. In some cases, surgical removal of the atelectatic area is required.

General information

Lung atelectasis (Greek “ateles” - incomplete + “ektasis” - stretching) is incomplete expansion or total collapse of lung tissue, leading to a decrease in the respiratory surface and impaired alveolar ventilation. If the collapse of the alveoli is caused by compression of the lung tissue from the outside, then in this case the term “lung collapse” is usually used. In the collapsed area of ​​lung tissue, favorable conditions are created for the development of infectious inflammation, bronchiectasis, fibrosis, which dictates the need to use active tactics in relation to this pathology. In pulmonology, pulmonary atelectasis can be complicated by a variety of diseases and lung injuries; Among them, postoperative atelectasis accounts for 10-15%.

Causes

Atelectasis of the lung develops as a result of restriction or impossibility of air flow into the alveoli, which can be due to a number of reasons. Congenital atelectasis in newborns most often occurs due to aspiration of meconium, amniotic fluid, mucus, etc. Primary atelectasis of the lung is characteristic of premature infants who have reduced education or lack of surfactant, an anti-atelectasis factor synthesized by pneumocytes. Less commonly, the causes of congenital atelectasis are lung malformations and intracranial birth injuries, which cause depression of the respiratory center.

In the etiology of acquired lung atelectasis, the greatest importance belongs to the following factors: blockage of the bronchial lumen, compression of the lung from the outside, reflex mechanisms and allergic reactions. Obstructive atelectasis can occur as a result of a foreign body entering the bronchus, the accumulation of a large amount of viscous secretion in its lumen, or endobronchial tumor growth. In this case, the size of the atelectatic area is directly proportional to the caliber of the obstructed bronchus.

The immediate causes of compression atelectasis of the lung can be any space-occupying formation of the chest cavity that puts pressure on the lung tissue: aortic aneurysm, tumors of the mediastinum and pleura, enlarged lymph nodes in sarcoidosis, lymphogranulomatosis and tuberculosis, etc. However, the most common causes of lung collapse are massive exudative pleurisy, pneumothorax, hemothorax, hemopneumothorax, pyothorax, chylothorax. Postoperative atelectasis often develops after surgical interventions on the lungs and bronchi. As a rule, they are caused by an increase in bronchial secretion and a decrease in the drainage function of the bronchi (poor coughing up of sputum) against the background of a surgical injury.

Distension atelectasis of the lungs is caused by impaired stretching of the lung tissue of the lower pulmonary segments due to limited respiratory mobility of the diaphragm or depression of the respiratory center. Areas of hypopneumatosis can develop in bedridden patients, in diseases accompanied by reflex limitation of inhalation (ascites, peritonitis, pleurisy, etc.), poisoning with barbiturates and other drugs, and paralysis of the diaphragm. In some cases, pulmonary atelectasis can occur as a result of bronchospasm and swelling of the bronchial mucosa in diseases of an allergic nature (asthmoid bronchitis, bronchial asthma, etc.).

Pathogenesis

In the first hours, vasodilation and venous congestion are noted in the atelectatic area of ​​the lung, leading to transudation of edematous fluid into the alveoli. There is a decrease in the activity of enzymes in the epithelium of the alveoli and bronchi and the redox reactions occurring with their participation. The collapse of the lung and the increase in negative pressure in the pleural cavity cause a displacement of the mediastinal organs to the affected side. With severe disturbances of blood and lymph circulation, pulmonary edema may develop. After 2-3 days, signs of inflammation develop in the focus of atelectasis, progressing to atelectatic pneumonia. If it is impossible to straighten the lung for a long time, sclerotic changes begin at the site of atelectasis, resulting in pneumosclerosis, bronchial retention cysts, deforming bronchitis and bronchiectasis.

Classification

By origin, pulmonary atelectasis can be primary (congenital) and secondary (acquired). Primary atelectasis is understood as a condition when a newborn child, for some reason, does not expand the lung. In the case of acquired atelectasis, there is a collapse of the lung tissue that was previously involved in the act of breathing. These conditions must be distinguished from intrauterine atelectasis (an airless state of the lungs observed in the fetus) and physiological atelectasis (hypoventilation that occurs in some healthy people and represents a functional reserve of lung tissue). Both of these conditions are not true pulmonary atelectasis.

Depending on the volume of lung tissue “switched off” from breathing, atelectasis is divided into acinar, lobular, segmental, lobar and total. They can be one- or two-sided - the latter are extremely dangerous and can lead to the death of the patient. Taking into account etiopathogenetic factors, pulmonary atelectasis is divided into:

• obstructive(obstructive, resorption) – associated with mechanical disruption of the patency of the tracheobronchial tree
• compression(lung collapse) – caused by compression of the lung tissue from the outside by the accumulation of air, exudate, blood, pus in the pleural cavity
• contractionary– caused by compression of the alveoli in the subpleural parts of the lungs by fibrous tissue
• acinar– associated with surfactant deficiency; found in newborns and adults with respiratory distress syndrome.

In addition, one can find a division of pulmonary atelectasis into reflex and postoperative, developing acutely and gradually, uncomplicated and complicated, transient and persistent. In the development of pulmonary atelectasis, three periods are conventionally distinguished: 1- collapse of the alveoli and bronchioles; 2 – phenomena of plethora, extravasation and local edema of the lung tissue; 3 – replacement of functional connective tissue, formation of pneumosclerosis.

Symptoms of pulmonary atelectasis

The severity of the clinical picture of pulmonary atelectasis depends on the rate of collapse and the volume of non-functioning lung tissue. Single segmental atelectasis, microatelectasis, and middle lobe syndrome are often asymptomatic. The most pronounced symptoms are characterized by acutely developed atelectasis of a lobe or the entire lung. In this case, sudden pain occurs in the corresponding half of the chest, paroxysmal shortness of breath, dry cough, cyanosis, arterial hypotension, and tachycardia. A sharp increase in respiratory failure can cause death.

Examination of the patient reveals a decrease in the respiratory excursion of the chest and a lag of the affected half during breathing. A shortened or dull percussion sound is determined above the focus of atelectasis, breathing is not audible or is sharply weakened. With gradual exclusion of lung tissue from ventilation, symptoms are less pronounced. However, subsequently atelectatic pneumonia may develop in the area of ​​hypopneumatosis. An increase in body temperature, the appearance of a cough with sputum, and an increase in symptoms of intoxication indicate the addition of inflammatory changes. In this case, pulmonary atelectasis may be complicated by the development of abscess pneumonia or even a lung abscess.

Diagnostics

The basis for the instrumental diagnosis of pulmonary atelectasis is X-ray examinations, primarily X-rays of the lungs in direct and lateral projections. The X-ray picture of atelectasis is characterized by homogeneous shading of the corresponding pulmonary field, a shift of the mediastinum towards atelectasis (in case of lung collapse - to the healthy side), a high position of the dome of the diaphragm on the affected side, increased airiness of the opposite lung. During fluoroscopy of the lungs, during inhalation, the mediastinal organs shift towards the collapsed lung, and during exhalation and coughing - towards the healthy lung. In doubtful cases, X-ray data are clarified using CT scan of the lungs.

To determine the causes of obstructive pulmonary atelectasis, bronchoscopy is informative. With long-standing atelectasis, bronchography and angiopulmonography are performed to assess the extent of the lesion. X-ray contrast examination of the bronchial tree reveals a decrease in the area of ​​the atelectatic lung and deformation of the bronchi. According to the APG data, one can judge the condition of the pulmonary parenchyma and the depth of its damage. A study of the blood gas composition reveals a significant decrease in the partial pressure of oxygen. As part of the differential diagnosis, agenesis and hypoplasia of the lung, interlobar pleurisy, relaxation of the diaphragm, diaphragmatic hernia, lung cyst, mediastinal tumors, lobar pneumonia, cirrhosis of the lung, hemothorax, etc. are excluded.

Treatment of pulmonary atelectasis

Detection of pulmonary atelectasis requires active, proactive tactics from the doctor (neonatologist, pulmonologist, thoracic surgeon, traumatologist). In newborns with primary atelectasis of the lung, in the first minutes of life, the contents of the respiratory tract are suctioned with a rubber catheter, and, if necessary, tracheal intubation and straightening of the lung are performed.

In case of obstructive atelectasis caused by a bronchial foreign body, therapeutic and diagnostic bronchoscopy is necessary to remove it. Endoscopic sanitation of the bronchial tree (bronchoalveolar lavage) is necessary if the collapse of the lung is caused by the accumulation of secretions that are difficult to cough up. In order to eliminate postoperative lung atelectasis, tracheal aspiration, percussion chest massage, breathing exercises, postural drainage, and inhalations with bronchodilators and enzyme preparations are indicated. For pulmonary atelectasis of any etiology, it is necessary to prescribe preventive anti-inflammatory therapy.

In case of lung collapse caused by the presence of air, exudate, blood and other pathological contents in the pleural cavity, urgent thoracentesis or drainage of the pleural cavity is indicated. In the case of prolonged existence of atelectasis, the impossibility of straightening the lung using conservative methods, or the formation of bronchiectasis, the question of resection of the affected area of ​​the lung is raised.

Prognosis and prevention

The success of lung expansion directly depends on the cause of atelectasis and the timing of treatment. If the cause is completely eliminated in the first 2-3 days, the prognosis for complete morphological restoration of the lung area is favorable. At later stages of lung expansion, the development of secondary changes in the collapsed area cannot be ruled out. Massive or rapidly developing atelectasis can lead to death. To prevent pulmonary atelectasis, it is important to prevent aspiration of foreign bodies and gastric contents, timely elimination of the causes of external compression of the lung tissue, and maintain airway patency. In the postoperative period, early activation of patients, adequate pain relief, exercise therapy, active coughing up of bronchial secretions, and, if necessary, sanitation of the tracheobronchial tree are indicated.

Lung atelectasis: what is it and why is it dangerous? The lungs are involved in the exchange of oxygen and carbon dioxide in the body. Through the lungs, carbon dioxide collected from all organs is removed and oxygen supplied with the air is supplied. Violation of the functions of the respiratory system leads to a lack of oxygen in the body and subsequent death.

Atelectasis of the lung is the collapse of one or more of its lobes with their exclusion from gas exchange. Air leaves the lung, but a new portion cannot enter.

The main reasons for the collapse of part of the lung are compression or blockage of the bronchi by a foreign body or sputum. Depending on the location of the damaged bronchus, atelectasis of the lower lobe of the right or left lung may develop. Collapse may also occur in the upper lobes of the lungs. When the lumen of a large bronchus is blocked, the function of the entire lung is disrupted; when smaller branches are damaged, part of it is damaged.

There are several forms of the disease: obstructive develops when the lumen of the bronchus narrows, which complicates the passage of air. The development of compression atelectasis of the lung is facilitated by compression of the organ by fluid. Distensional collapse of the lung on the left occurs when it is impossible to straighten the pulmonary alveoli during inspiration. With a mixed form of pathology, all the above reasons are combined. According to the prevalence, pulmonary atelectasis can be:

• full;
• focal;
• partial.

Due to its occurrence, the disease can be congenital or acquired. Congenital forms of pathology are associated with the inability to open the lungs in premature infants, which leads to oxygen starvation. Acquired atelectasis of the upper lobe of the lung occurs against the background of upper respiratory tract infections, foreign objects entering the bronchi, and chest compression.

Main symptoms of pathology

The severity of symptoms increases in proportion to the size of the lung lesion and the speed of its development. With a large size of the affected area and the rapid development of atelectasis, symptoms of oxygen starvation are noted: shortness of breath, chest pain, rapid heartbeat, drop in blood pressure, cyanosis of the skin. If atelectasis of the lung occurs in one of its lobes, signs may be absent. However, this does not mean the absence of the disease. Sooner or later it will manifest itself.

Atelectasis of the middle lobe of the lung, as well as any other parts of the organ, occurs against the background of blocking the lumen of the bronchi with blood, sputum, and vomit. The bronchi may be compressed in the presence of benign and malignant neoplasms in the thoracic region, pleurisy or pneumothorax. Atelectasis is caused by:

• mechanical damage during surgery;
• postoperative tissue scarring;
• inflammatory processes;
• dysfunction of the brain;
• congenital defects of lung tissue, leading to a decrease in their elasticity.

Diagnosis and treatment of the disease

In order to prescribe the most effective treatment, the doctor must conduct a full examination, which helps to identify the main causes of the development of the pathology, its stage and extent. First of all, the specialist interviews the patient, collects information about previous diseases, examines the patient and measures vital signs of the body. The initial examination of the patient includes measuring pulse, blood pressure, listening to the lungs, and examining the skin. Then an X-ray examination and computed tomography are performed to determine the nature of changes in the lung tissues.

Treatment of a disease such as atelectasis of the left lung lobe is carried out in several directions. First of all, it is necessary to eliminate the cause of tissue collapse, then straighten them and restore gas exchange. Physiotherapy consists of postural drainage. This is the performance of special exercises that help remove fluid, foreign body or blood from the lungs.

Massage of the chest area improves mucus discharge. During bronchoscopy, an instrument is inserted into the lumen of the bronchi to examine the respiratory organs and remove blockages. If pulmonary atelectasis is associated with the presence of mucus in the bronchi, it is necessary to take mucolytic drugs. Treatment of collapse of lung tissue associated with pleurisy is performed by inserting a needle into the pleural space and pumping out the pathological exudate. Bronchial catheterization and oxygen inhalation have a good effect.

This video talks about pulmonary atelectasis:

In the presence of large tumors and the risk of bleeding, surgical treatment is indicated. Taking antibiotics helps prevent bacterial infections. Etimizole helps restore respiratory function. Preventive measures include: physiotherapy, massage, breathing exercises, periodic change of position (for bedridden patients).

The life expectancy of a patient with atelectasis of the right lung, as well as the left, depends on the timeliness of treatment.

If the disease is detected in the early stages, the prognosis for recovery is favorable. In advanced forms, life expectancy is significantly reduced. People with a completely collapsed lung can live from a few days to several months. Against the background of atelectasis, other pathologies often develop, leading to death.

This video talks about the treatment of pulmonary atelectasis:

Serious complications of the collapse of one of the lobes can be: oxygen deficiency, lung abscess, pneumonia. If the right or left side of the respiratory system is completely affected, death occurs in almost all cases. Obstructive atelectasis is one of the most life-threatening forms of the disease; compression and distension types of collapse can be eliminated provided proper treatment is carried out.

is a pathological condition of the entire respiratory organ or part of it, caused by the absence of air or its insufficient amount in the alveoli. This phenomenon is called collapse of the lung and is possible due to a lack of surfactant , blockage of the lumens of the bronchial tubes or as a result of compression of the respiratory organ. It is important to distinguish physiological atelectasis of the part of the lung where hypoventilation is observed at rest and is a reserve in case of physical activity.

Pathogenesis

With atelectasis, there is a diffusion reduction in the surface of the lungs, a collapse of part of the alveoli and a reduction in their number that are able to function normally.

It is known that in the structure of the lungs there are more than 300 million alveoli, in which blood is perfused in parallel and sequentially during ventilation. This ensures gas exchange between the air in the alveoli and in the pulmonary capillaries. In the case of atelectasis, there is no perfusion in non-ventilated areas and gas exchange does not occur, which leads to respiratory failure. Aggravation of the processes causes extravasation and the formation of local edema. Subsequently, it is formed pneumosclerosis - functional parenchyma is replaced by connective tissues.

Classification

Atelectasis should be divided according to the time of occurrence (congenital or acquired) and according to its prevalence:

• total;
• partial, which occurs in one or several lobes - lobar, in segments - segmental, and also in the basal sections - discoid.

Atelectasis of the lower lobe of the left lung

Lobar atelectasis is usually associated with blockage of the lobar or segmental bronchi, because the bronchial tree is a whole system of air ducts, which originates from the trachea and is divided into 2 lungs by the main - the widest bronchi, branches to bronchioles, in total there are 21 orders of bronchi.

Atelectasis of the lower lobe leads to constriction of the lower part of the mediastinum - a complex of organs between the pleural cavities, including the heart, esophagus, thymus gland, etc.

Atelectasis of the upper lobe of the right lung

Atelectasis of the upper lobe is characterized by slight tugging of the upper mediastinum. The pathology leads to compensatory swelling of the middle lobe and the apex of the lower lobe.

Discoid atelectasis of the lung

Disc-shaped decline of the parenchyma of adjacent lobes of the lung is observed in diffusion pathologies of the bronchial tree, which are most often caused pneumonitis , fibrosing alveolitis , .

Middle lobe syndrome

A type of atelectasis in which obstruction of a large bronchus in the middle lobe of the right lung occurs (it is absent in the left), for example, by an enlarged lymph node caused by previous inflammatory diseases, or as a result of oncology.

In addition, atelectasis is distinguished depending on the cause and mechanism of development of the pathology:

• obstructive (resulting from blockage of the respiratory system);
  functional (caused by disturbances in the process of expansion of the lung during inhalation);
• compression (the basis of the pathology is squeezing - compression);
• mixed (possibly a combination of the above reasons).

Obstructive atelectasis

The obstructive mechanism for the development of pathology is caused by blockage of the bronchial lumen with foreign bodies, vomit, sputum, blood, and neoplasms. Sometimes there is complete closure of the lumen, the so-called distelectasis . In places where the air flow is blocked, its resorption occurs - resorption in the pulmonary capillary system, congestive plethora and other disorders of lymph and blood circulation occur, and sclerosis processes are possible. If the obstructing factor is not eliminated within three days, this leads to irreversible consequences.

Functional atelectasis

Most often found in bedridden patients, it is associated with disturbances in the mechanics of movements of the diaphragm, a decrease in its mobility or depression of the respiratory center. Observed hypopneumatosis and a violation of the respiratory stretch of individual, most often the basal lobes, as in the discoid type.

In addition, disturbances in the diaphragmatic movement of breathing and the depth of inspiration can occur with increased intra-abdominal pressure (with ascites , ) are caused by acute pain (for example, with fibrinous pleurisy, peritonitis ), with too tight corsets and medical bandages, as well as as a result aperture .

Compression atelectasis

In another way, compression collapse of the lung is called collapse and occurs when the lung is compressed by gases or liquid from the outside (exudate, transudate, blood, fibrous tissue). The compression mechanism of atelectasis development has a more optimistic prognosis during treatment, since there are no endobronchial factors in the pathogenesis - collapse of the lung does not cause pronounced lymph retention or congestion.

Causes of pulmonary atelectasis

Causes of atelectasis in newborns and in patients with previously expanded and breathing lungs:

• primary congenital pathology is possible as a result of blockage of the respiratory tract, flooding with amniotic fluid, mucus, as well as insufficient surfactant, which normally maintains the alveoli in a straightened state;
• secondary atelectasis can occur when the alveoli are “flooded,” for example, by inflammatory exudate during pneumonia , as a result of intrathoracic tumors, pleural effusion, pulmonary infarction , enlargement of the lymph node, cyst formation, accumulation of pus, as well as air and fluid in the pleural cavities - pneumatic And hydrothorax , mechanical blockage with foreign bodies, vomit, blood, mucus, sputum, etc.

In addition, collapse of the lung (reflex) can occur as a result of injury, for example, rib fractures, barbiturate poisoning, bronchospasm, impaired ventilation during surgery, etc.

Symptoms

The manifestations of rapidly developing atelectasis differ from the gradual onset of such a pathology. The patient usually:

• experiencing severe chest pain;
• pulse quickens;
• increased shortness of breath occurs;
• there is cyanosis and a lag during breathing acts in the affected area of ​​the chest compared to the healthy side;
• decreased breathing and voice tremors;
• complications of infections, manifested in the form of fever.

Obstructive atelectasis syndrome manifests itself in the form of an unproductive cough and upon auscultation in the affected area, breathing cannot be heard or is sharply weakened.

Whereas the slow development of atelectasis is accompanied by subtle clinical manifestations and radiography is necessary for detection. It can lead to sclerotic changes in the lung tissue - the so-called fibroatelectasis .

Tests and diagnostics

In addition to studying the anamnesis, life history and surgical interventions, they examine the skin, listen to the lungs with a phonendoscope, assess the state of the cardiovascular system and prescribe such studies of airless areas of the lungs and airiness of the lung tissue as:

• radiography;
• tomography;
• bronchography.

Treatment

Treatment of atelectasis is aimed at activating and restoring respiratory function in full, clearing mucus plugs and restoring air patency (bronchoscopy, suction of tracheal contents), aeration of non-ventilated parts of the lung, and stopping a secondary infectious process. For this, expectorants, mucolytic and antibiotic drugs are used.

The doctors

Medicines

• To stimulate the respiratory center and enhance the synthesis of surfactant, it is prescribed.
• Bronchodilators are important - , Servent .
• During exacerbations of the infectious process, a mucolytic is effective.

Procedures and operations

In case of compression atelectasis, the following is carried out:

• drainage of the pleural cavity;
• pleural punctures.

For bronchial tumors, surgery, radiation or conservative treatment may be indicated.

For mechanical blockage and removal of mucus and pus, a bronchoscope and an “artificial cough” apparatus are used.

In case of functional pathology - distensional functional atelectasis, breathing exercises are recommended, as well as inhalation of mixtures of gases, carbon dioxide, oxygen, etc. The last resort is resection of the atelectic part of the lung.

In children

The most common cause of atelectasis (acinar type) in newborns is a violation of the synthesis of surfactant, a complex of phospholipids produced by type II alveolar cells. Thanks to the surfactant, the surface tension in the area of ​​separation of the phases of air and water is reduced, which ensures the stabilization of the alveoli during exhalation; with its deficiency, respiratory problems develop neonatal distress syndrome and the alveoli collapse. As a result, the diffusion surface of the lungs leads to restrictive (restrictive) type and worsening hyalinization of alveolar membranes.

Atelectasis in children, as a primary failure to straighten terminal respiratory structures, also occurs as a result of hypoplasia or immaturity associated with prematurity.

In some cases, in infants after childbirth, the lungs do not expand completely due to mechanical blockage of the lumens of the bronchial tubes with mucus. Possible “flooding” of amniotic fluid as a result of asphyxia during childbirth, when the respiratory center is activated before the first breath.

List of sources

• Ado A.D. Pathological physiology. Textbook for medical schools. Moscow Triad-X, 2000, - 285 S.
• Nikolaev A.V. Topographic anatomy and operative surgery. - 2nd ed., rev. and additional.. - 2009, T. 2, - 480 p.
• Paleeva N.R. Respiratory diseases / M.: Medicine, 2000, - 699 p.

Atelectasis is a pathological condition in which the lung tissue loses its airiness and collapses, reducing (sometimes significantly) its respiratory surface. The result of the collapse of part of the lung is a decrease in gas exchange with an increase in the phenomena of oxygen starvation of tissues and organs, depending on the volume of the area that has lost its airiness.

Shutting down the right or left lower lobes reduces lung capacity by 20%. Atelectasis of the middle lobe reduces it by 5%, and one of the segments of any of the apical lobes - by 7.5%, forcing compensatory mechanisms to come into play, which manifest themselves in the form of symptoms characteristic of atelectasis.

At the same time, atelectasis should not be confused with zones of physiological hypoventilation of the lungs when a healthy person is at rest, which does not require active consumption of oxygen from the air.

The mechanism of formation of pulmonary atelectasis and its causes

1. Local narrowing of the lumen of the bronchial tree:

• In cases of compression from the outside by a lung tumor located next to the bronchus;
• With local enlargement of lymph nodes, which accompanies inflammatory and tumor processes;
• During processes occurring in the wall of the bronchus (with increased mucus formation or discharge of pus, bronchial tumor with growth into the lumen of the vessel);
• Entry of foreign bodies (aspiration from vomit, choking).

As a rule, this mechanism is realized with an additional reflex (contraction of the smooth muscles of the bronchi), which further narrows the airways.

2. Collapse of the lung tissue itself:

• When the air pressure inside the alveoli decreases (violation of inhalation anesthesia technique);
• Sudden change in ambient air pressure (fighter pilot atelectasis);
• Decreased production or absence of surfactant, leading to increased surface tension of the inner wall of the alveoli, causing them to collapse (neonatal respiratory distress syndrome);
• Mechanical pressure on the lung from pathological contents located in the pleural cavities (blood, hydrothorax, air), an enlarged heart or a large aneurysm of the thoracic aorta, a large focus of tuberculous lesions of lung tissue;
• When interstitial pressure exceeds intra-alveolar pressure (pulmonary edema).

3. Suppression of the breathing center in the brain

Occurs with traumatic brain injuries, tumors, general (intravenous, inhalation) anesthesia, excessive oxygen supply during artificial ventilation, and overdose of sedatives.

4. Violation of the integrity of the bronchus due to a simultaneous rapid mechanical impact on it

It is observed during surgery (ligation of the bronchus as a method of surgical treatment for) or during its injury (rupture).

5. Congenital malformations

Hypoplasia and aplasia of the bronchi, the presence of tendon septa in the form of intrabronchial valves, esophageal-tracheal fistulas, defects of the soft and hard palate.

With all opportunities being equal, the following people have an increased risk of developing pulmonary atelectasis:

• Smoking;
• Having increased body weight;
• Suffering from cystic fibrosis.

Classification of pulmonary atelectasis

Depending on the order of involvement of the lungs in the pathological process:

Primary (congenital)

It occurs in children, most often immediately after their birth, when the lungs do not fully expand with the first breath. In addition to the already described intrauterine anomalies in the development of the lungs and insufficient production of surfactant, the cause of its occurrence can be aspiration of amniotic fluid, meconium. The main difference between this form is the initial absence of air from the environment entering the collapsed area of ​​lung tissue.

Secondary (acquired)

This form of atelectasis occurs as a complication of inflammatory and tumor diseases of organs, both respiratory and other systems, as well as with chest injuries.

Various forms of pulmonary atelectasis

According to the mechanism of occurrence, acquired forms of atelectasis are distinguished:

Obstructive atelectasis

It is observed when the cross-sectional area of ​​the bronchus decreases for the reasons stated above. Obstruction of the lumen can be complete or partial. Sudden closure of the lumen when a foreign body enters requires immediate action to restore the patency of the bronchial tree for the reason that with each hour of delay the likelihood of straightening the collapsed section of the lungs decreases. Restoration of lung ventilation in cases where complete obstruction of the bronchus lasted more than three days does not occur.

Compression atelectasis

Occurs when there is a direct impact on the lung tissue itself. A more favorable form, in which complete restoration of pulmonary ventilation is possible even after a fairly long period of compression.

Functional (distensional) atelectasis

Occurs in areas of physiological hypoventilation (lower segments of the lungs):

1. In bedridden patients;
2. Those who have undergone severe and prolonged surgical interventions;
3. In case of overdose of barbiturates, sedatives;
4. With arbitrary limitation of the volume of respiratory movements, which is caused by severe pain (rib fracture, peritonitis);
5. In the presence of high intra-abdominal pressure (ascites of various origins, chronic constipation, flatulence);
6. With diaphragmatic paralysis;
7. Demyelinating diseases of the spinal cord.

Mixed atelectasis

With a combination of different mechanisms of origin.

Depending on the level of bronchial obstruction and the area of ​​lung collapse, the following are distinguished:

• Lung atelectasis (right or left). Compression at the level of the main bronchus.
• Lobar and segmental atelectasis. Lesion at the level of the lobar or segmental bronchi.
• Subsegmental atelectasis. Obstruction at the level of the bronchi of the 4th-6th order.
• Discoid atelectasis. Disc-shaped atelectasis develops as a result of compression of several lobules located within the same plane.
• Lobular atelectasis. Their cause is compression or obstruction of the terminal (respiratory) bronchioles.

Signs of pulmonary atelectasis

The severity of the symptoms, due to which one can suspect the occurrence of atelectasis in the lungs, depends on a number of reasons:

1. The rate of compression of lung tissue (acute and gradually increasing atelectasis are distinguished);
2. Volume (size) of the respiratory surface of the lungs turned off from ventilation;
3. Localizations;
4. The mechanism of occurrence.

Dyspnea

It is characterized by an increase in the frequency of inhalation and exhalation per minute, a change in their amplitude, and arrhythmia of respiratory movements. Initially, the feeling of lack of air occurs during physical activity. With increasing or initially large area of ​​atelectasis, shortness of breath appears at rest.

Chest pain

Optional attribute. Appears most often when air enters the pleural cavities.

Change in skin color

Caused by excess carbon dioxide in tissues. In children, first of all, the nasolabial triangle turns blue. In adults, blueness of the fingers of the extremities (acrocyanosis) and the tip of the nose appears.

Changes in the performance of the cardiovascular system

• Pulse increases (tachycardia);
• After a short-term increase in blood pressure in the initial stages, it decreases.

In children, the indicated symptoms are also observed, which are most clearly manifested in newborns with primary atelectasis. These are accompanied by easily observed retractions of the intercostal spaces when inhaling from the side of the affected lung, as well as retractions of the sternum when air enters the lungs.

Diagnostics

During medical diagnosis, in addition to the symptoms noticeable to the patient, the following signs of atelectasis can be identified:

1. The sound when tapping the chest (percussion) in the area of ​​atelectasis becomes shorter and less sonorous (dullness), in contrast to the more “boxy” sound in the surrounding areas.
2. Weakening or complete absence of breathing during auscultation in the projection of atelectasis, asymmetry in the movements of the diseased and healthy half of the chest.
3. With atelectasis, which covers all or almost all of the lung, the heart shifts towards the collapsed organ. This can be detected by percussion of the borders of the heart, by changes in the localization of the apex beat zone, and by auscultation of the heart.

You should also remember:

• Signs of atelectasis occur against the background of an existing underlying disease, sometimes aggravating the already critical general condition of the patient.
• The collapse of a segment (in some cases even a lobe) of the lung may go unnoticed for the patient. However, it is these small collapsed areas that can become the first foci of pneumonia, which is severe in such patients.

An X-ray examination of the chest organs helps to clarify the presence of atelectasis, its location and extent in order to determine treatment tactics. It is carried out in at least two projections. In more difficult cases, tomography is used to diagnose cases.

X-ray signs that suggest the presence of atelectasis:

1. Change in density (darkening) of the shadow of a compressed area of ​​the lungs in comparison with the surrounding tissues, often following the contours of a segment or lobe;
2. Change in the shape of the dome of the diaphragm, displacement of the mediastinal organs, as well as the roots of the lungs towards atelectasis;
3. The presence of functional signs of bronchoconstriction (not necessary if the mechanism of atelectasis is not obstructive);
4. Approximation of the shadows of the ribs on the affected side;
5. Scoliosis of the spine with the direction of the convexity towards atelectasis;
6. Stripe-like shadows against the background of unchanged areas (disc-shaped atelectasis) of the lungs.

Atelectasis of the middle lobe of the right lung on x-ray

Prognosis for pulmonary atelectasis

Sudden simultaneous total (subtotal) atelectasis one or two lungs, developed as a result of trauma (air entering the chest) or during complex surgical interventions in almost all cases ends in death immediately or in the early postoperative period.

Obstructive atelectasis, developed due to sudden blockage by foreign bodies at the level of the main (right, left) bronchi - also have a serious prognosis in the absence of emergency help.

Compression and distension atelectasis, developed during hydrothorax, with the removal of the cause that caused them, do not leave any residual changes and do not change the volume of the vital capacity of the lungs in the future.

The prognosis for the restoration of the functions of a compressed lung can be significantly changed by the attached lung, which in these cases leaves scar tissue replacing the collapsed alveoli.

Treatment

1. Elimination of the mechanism of atelectasis with restoration of ventilation in these areas

For obstructive atelectasis:

For compression atelectasis:

1. Pleural puncture with removal of effusion and air from the cavities, eliminating the causes of effusion and communication with the environment;
2. Surgical treatment of tumors of the lungs and lymph nodes, elimination of cavitary formations (cysts, abscesses, some forms of tuberculosis).

For distensional atelectasis:

• Breathing exercises with the creation of high intrabronchial pressure (inflating balloons);
• Inhalation with a mixture of air and 5% carbon dioxide to stimulate the respiratory center.

2. Artificial ventilation with the addition of oxygen

It is carried out when severe symptoms develop.

3. Correction of acid-base balance disorders in the blood

It is carried out by prescribing intravenous infusion therapy based on the patient’s biochemical blood data.

4. Antibiotic therapy

Aimed at preventing purulent complications.

5. Syndromic therapy

Includes elimination of the pain factor if present, correction of cardiovascular activity (normalization of pulse, blood pressure).

6. Physiotherapy

Chest massage is one of the methods of treating pulmonary atelectasis

It is carried out to prevent the formation of scars in the lungs and improve blood circulation in the area of ​​atelectasis. For this purpose, UHF irradiation is used in the acute phase, and during the recovery period, electrophoresis with drugs (platifillin, aminophylline, etc.) is used.

7. Therapeutic and preventive physical education and chest massage

Aimed at improving the functioning of the respiratory muscles. A light vibration massage promotes the removal of sputum and mucus from the bronchoalveolar tree.

Video: pulmonary atelectasis in the program “Live Healthy!”