Compressed lungs. Discoid atelectasis: causes, diagnosis and treatment

What it is? Atelectasis is a lung condition that develops in the absence of air in the lung tissue. Usually, air presses on the walls of the pulmonary vesicles, causing them to take on a filled shape, resembling a bunch of grapes.

If there is no air, the lung, as it were, “deflates”, loses its fullness and volume. However, if surfactant is present, the lung alveoli do not stick together. But, in the absence of this substance, there is a collapse and adhesion of the pulmonary vesicles - this is called lung atelectasis.

Symptoms of atelectasis by type

Atelectasis is divided into two fundamentally different groups, depending on whether the lungs were breathing before it developed or not. If there was no respiratory activity in the lungs - atelectasis will be primary or congenital, if the lungs worked - secondary, or acquired.

Primary atelectasis develops only in newborns. The reasons for its occurrence lie in the underdevelopment of the lung tissue, in the ingestion of meconium and amniotic fluid, which after birth prevent the lungs from filling with air and their physiological opening, as well as as a result of depression of the respiratory center during birth head injuries.

In some cases, hereditary deficiency of surfactant may be observed.

Congenital atelectasis can be focal and extensive. In the first case, there is shortness of breath, cyanosis of the skin around the mouth (nasolabial triangle), if the affected area is small, there are no symptoms. Extensive primary atelectasis is manifested by severe shortness of breath, discoloration of the skin, can lead to development, often ends in the death of the newborn.

Aspiration pneumonia is especially dangerous when meconium (original feces) enters the lungs. This leads to aggressive inflammation, which provokes the development of acute respiratory failure, leading to death.

The largest is total atelectasis. Then, in descending order of the affected area, there is atelectasis of the lobe of the lung, segmental and lobular atelectasis. The smallest in size is discoid atelectasis of the lung. It practically does not show clinical manifestations.

According to the mechanism of development, acquired atelectasis is divided into 4 types.

Obstructive atelectasis

Obstructive atelectasis is associated with the occurrence of an obstacle to the flow of air inside the lungs, which can be located at different levels. The deeper and closer to the alveoli the block is located, the smaller the area of the lung will be deprived of air, respectively, the clinical symptoms will be less pronounced.

The reasons that block the lumen of the bronchi are:

foreign body;
Mucus plug;
Very thick expectoration;
Tumor inside the bronchus. The most common cause is bronchogenic;
Compression of the bronchus from the outside by a tumor, scar tissue, an enlarged lymph node during metastasis of malignant neoplasms.

With obstructive atelectasis, symptoms may be absent for some time or develop gradually. Shortness of breath usually appears and increases, which is complemented by a dry cough, persistent and not bringing relief. Difficulty breathing when breathing.

On the “problem” side: the chest decreases in volume, the intercostal spaces are narrowed, the shoulder is lowered, the spine is shifted to the healthy side. The skin is bluish in color. Pneumonia is a common complication of obstructive atelectasis.

The development of pneumonia in atelectasis is due to the fact that an increased negative pressure is created on the side of the lesion, which leads to a violation of the lymph and blood circulation; there is a "pulling" of fluid, blood cells, mucus into the lumen of airless bronchi.

Under such conditions, microorganisms easily penetrate into the lung tissue, leading to infection. Against this background, the development of pulmonary edema and subsequent acute hypoxia of the body is possible.

Compression atelectasis

Compression atelectasis occurs if any pathological "volume" appears in the pleural cavity, which begins to gradually compress the lung tissue. An increase in the severity of the primary process leads to an increase in the volume of the compressive factor and the appearance of symptoms of atelectasis.

Factors that put pressure on the lungs from the inside are:

A large amount of inflammatory fluid, which is a consequence of pleurisy - an inflammatory process of the membranes of the lungs against the background of pneumonia, tuberculosis, systemic diseases (SLE, rheumatism) and other processes;
Hydrothorax - accumulation of fluid around the lungs during poor heart function, when blood stagnation occurs in the pulmonary veins and the liquid part of the blood begins to seep into the pleural cavity;
- air entering the lung cavity from the inside and outside with chest injuries;
Hemothorax - blood in the pleural cavity with massive bleeding associated with injuries;
Large swelling coming from the lungs or bronchi.

Manifestations of symptoms of compression atelectasis occur against the background of the underlying disease and increase gradually. The main specific clinical signs will be shortness of breath, shortness of breath, both inhalation and exhalation, cough, feeling of heaviness and pain in the affected half of the chest.

With compression atelectasis, signs of cyanosis (cyanosis) of the lips and skin are noted. On the side of the development of the collapse of the lungs, the chest is enlarged, there is swelling of tissues in the intercostal spaces, a noticeable lag of this half during breathing.

Compression atelectasis differs from obstructive atelectasis in the nature of shortness of breath. In the first case, it is mixed, i.e. as mentioned above, it is difficult to inhale and exhale. In the second case, it is expiratory in nature, i.e. only exhalation is difficult due to the existing obstacle.

Distension atelectasis

Distension atelectasis refers to a functional type in which there is a decrease in the filling of the lungs with air during inhalation due to limitation of the volume of respiratory movements and bronchospasm.

Causes, main symptoms and signs of pleural hydrothorax:

Occurs due to the limited mechanics of respiratory movements:

In patients on prolonged bed rest in the lower lateral parts of the lungs;
When a person deliberately does not take a deep breath due to pain in the chest or abdomen;
When the accumulation of air or fluid in the abdominal cavity interferes with inhalation (i.e., is the result of flatulence, ascites);
Decreased bronchial elasticity and muscle tone in myasthenia gravis.

Distension atelectasis can also occur when the respiratory center of the brain is depressed, which leads to weakened breathing and reflex bronchospasm:

after anesthesia;
in case of poisoning with barbiturates;
with a stroke - such atelectasis is called spastic, or contractile.

Signs of this type of pathology are often absent, due to its small size. With multiple foci, it can manifest itself as slight shortness of breath and dry cough. The chest is not asymmetric, its size, as a rule, is not changed.

When listening to the lungs at a deep entrance, you can hear the appearance of wheezing, which are associated with the disclosure of collapsed areas of the lungs. Unlike pneumonia, these wheezing are unstable and disappear after a few breaths.

Mixed atelectasis

Mixed atelectasis occurs when two or three types of secondary atelectasis are combined. This is observed when an abscess of the lungs occurs, a focus of inflammation in pneumonia, a cavity in tuberculosis.

These conditions have a less favorable prognosis than all others.

Ways of infection with pulmonary tuberculosis, the first signs and symptoms that should alert:

In addition to the survey and objective examination, including percussion and auscultation of the chest, an X-ray examination is performed in two positions of the body (in 2 projections). This is the main method for detecting lung atelectasis.

On x-rays, the following signs are revealed, indicating a collapse of the lung tissue:

Homogeneous darkening in the affected area. The size of the shadow depends on the type of atelectasis: with lobar atelectasis, extensive blackout is detected, with segmental atelectasis, in the form of a wedge or triangle located with its apex to the root of the lung, lobular atelectasis is multiple and looks like focal pneumonia. Distensional atelectasis is located low, near the diaphragm, has a small size and the appearance of transverse stripes or dark discs.
Displacement of organs: with compression atelectasis, displacement is observed in the healthy direction, since pressure is greater on the side of the lesion, with obturation, on the contrary, the displacement will be in the direction of atelectasis, since an attractive negative pressure increases on the side of the lesion.
Elevation of the dome of the diaphragm - this can be seen from the location of the liver.

In addition to all of the above, fluoroscopy, that is, a “live” study, allows you to see where the organs are moving depending on the phase of breathing, coughing. This is an additional sign of atelectasis, helping to identify the type of disease.

A preliminary, x-ray diagnosis is the "syndrome of the right lobe", in which a darkening of the area of \u200b\u200bthe middle lobe of the right lung is revealed.

The frequent occurrence of atelectasis of the right lung is associated with the anatomical features of the right middle lobe bronchus: it is narrow and long, so it often overlaps during the pathological process.

If the diagnosis is not clear, X-ray examination is supplemented with computed tomography. When the lumen of the bronchi is blocked, bronchoscopy is performed - examination along the bronchi with a probe with a camera, which is inserted into the respiratory tract.

The study reveals the cause of the block and the level of its location.

Prolonged atelectasis requires contrastive research methods: bronchography and angiopulmonography. The study provides information about the depth of the lesion of the left and right lungs, reveals the deformation of the bronchi, and also evaluates the course of the vessels.

The study of the gas composition of the blood reveals a decrease in the partial pressure of oxygen to a large extent. This diagnostic test determines the degree of acute respiratory failure, leading to total hypoxia.

Symptoms, diagnosis and treatment of acute bronchitis in adults:

Treatment of atelectasis in newborns consists in cleansing the airways by suctioning the contents through a catheter, in severe cases, artificial ventilation and straightening of the lungs are performed. With immature lungs, measures are prescribed to improve the maturation of the surfactant.

First of all, this is the introduction of drugs based on this substance. It is important to note that during meconium aspiration, the original feces should be immediately removed from the respiratory tract using an electric suction that creates a negative pressure.

Measures to eliminate secondary atelectasis are combined with the treatment of the underlying disease.

In the treatment of obstructive atelectasis, bronchoscopy is performed: a foreign body, a viscous secret, is removed from the bronchi.
Atelectasis caused by a tumor is eliminated after surgical treatment of the underlying disease, i.e. surgery, chemotherapy and radiation may be performed.
Compression atelectasis requires urgent thoracocentesis - piercing with a special needle of tissues in the intercostal space, followed by removal of air or fluid from the pleural cavity. This eliminates mechanical compression of the lung tissue.

If postoperative forms of the disease occur, a chest massage is performed by tapping, inhalation with bronchodilators (substances that dilate the bronchi), exercise therapy. Early activation of the patient is important if he is in a horizontal position for a long time, for example, with a fracture of the femur.

Surgical treatment of atelectasis is indicated for prolonged, chronic lung collapses that cannot be straightened by conventional methods. During the operation, the affected part of the lungs is removed.

Any type of this pathology requires the appointment of anti-inflammatory therapy, and when an infection is attached, antibiotics.

Atelectasis of the lung is a rather dangerous disease in which airlessness of the lung tissue is observed. This means that there is insufficient expansion or diffuse collapse of the tissues of this organ. There are a large number of predisposing factors that lead to the development of such an ailment, ranging from congenital anomalies to long-term addiction to smoking cigarettes.

The clinical picture is dominated by specific symptoms, which are expressed in the sternum, shortness of breath and cyanosis of the skin.

It seems possible to make a correct diagnosis on the basis of a physical examination and instrumental examinations of the patient. Treatment of lung atelectasis is often conservative, but advanced forms may require surgery.

The International Classification of Diseases highlights its own significance for such a pathology. ICD-10 code - J98.1.

Etiology

Since the disease is congenital or acquired, the causes of occurrence will be somewhat different.

Atelectasis of the lung in a newborn may be due to:

ingestion of meconium, amniotic fluid or mucus into the lungs of an infant;
a decrease in the formation or complete absence of a surfactant-antiatelectic factor, which is synthesized by pneumocytes;
malformations of the formation or functioning of the left or right lung;
injuries of an intracranial nature, received during labor - against this background, inhibition of the functioning of the respiratory center is noted.

Other sources of the development of the disease in adults and children can be:

obstruction of the lumen of the bronchus;
prolonged external compression of the lung;
pathological reactions of an allergic nature;
reflex mechanisms;
entry into the bronchi of a foreign object;
accumulation of significant volumes of viscous liquid;
any volumetric benign or malignant neoplasms in the chest area, which lead to compression of the lung tissue.

The most common causes of lung atelectasis are represented by the following ailments:

hemopneumothorax;
pyothorax;
chylothorax.

In addition, such a disease is often the result of operable treatment carried out on the bronchi or lungs. At the same time, an increase in bronchial secretion and a decrease in the drainage capacity of these organs develop.

Often, pathology occurs in bedridden patients who have suffered a severe course of ailments, which are characterized by reflex limitation of inspiration. They should include:

and drug poisoning;
paralysis of the diaphragm;
diseases of an allergic nature that cause swelling of the mucous layer of the bronchus.

In addition, it is worth highlighting the main risk groups that are most susceptible to collapse of the lungs:

age category under three years and over sixty years of age;
prolonged adherence to bed rest;
rib fractures;
premature babies;
uncontrolled intake of certain medications, in particular sleeping pills or sedatives;
chest deformities;
the presence in a person of any neurogenic condition that can lead to respiratory muscle weakness;
high body mass index;
long-term abuse of such a bad habit as smoking cigarettes.

Classification

In pulmonology, a large number of varieties of such a disease are distinguished. The first of them involves the division of the disease depending on its origin:

primary- is diagnosed in infants immediately after birth, when, due to the influence of one or another factor, he could not take his first breath, and the lung did not fully expand;
secondary- is acquired. In such cases, there is a collapse of the lung, which has already taken part in the process of breathing.

It is worth noting that the above forms should not be confused with the collapse that developed in utero and is observed in a child in the womb, as well as the physiological atelectasis inherent in every person. The intrauterine and physiological form do not belong to the category of true atelectasis.

According to the prevalence of the pathological process, the disease is divided into:

acinous;
lobular;
segmental;
equity;
diffuse.

According to the etiopathogenetic principle, the following types of the disease are distinguished:

obstructive- is formed due to obstruction of the bronchi caused by mechanical disorders;
compression atelectasis of the lung- is caused by external compression of the lung tissue, for example, air, pus or blood that accumulates in the pleural cavity;
contractual- caused by compression of the alveoli;
acinar- is diagnosed in both children and adults in cases of leakage.

The development of the disease goes through several stages:

light- expressed in the collapse of the alveoli and bronchioles;
moderate- characterized by the appearance of plethora and swelling of the lung tissue;
heavy- healthy tissue is replaced by connective tissue. This is where development takes place.

Depending on the image obtained after the X-ray, the pathology has several types:

discoid atelectasis- develops against the background of compression of several lobules of the lung;
subsegmental atelectasis- characterized by complete obturation of the left or right lung;
linear atelectasis.

In addition, the following classifications of such a disease are distinguished:

according to the degree of compression of the lung tissue - acute and gradual;
by the presence of consequences - uncomplicated and complicated;
by the nature of the flow - passing and persistent;
according to the mechanism of appearance - reflex and postoperative;
according to the affected area - unilateral and bilateral.

Symptoms

The degree of intensity of the signs of the clinical picture will directly depend on the volume of the lung involved in the pathological process. For example, microatelectasis or damage to only one segment of the lung can be completely asymptomatic. In such cases, the pathology will be a diagnostic finding, which is often detected during the passage of an x-ray for prophylactic purposes.

The disease is most acutely manifested when an entire lobe of this organ is affected, in particular, atelectasis of the upper lobe of the right lung. Thus, the basis of the clinical picture will be the following signs:

shortness of breath - it appears suddenly both during physical exertion and at rest, even in a horizontal position;
pain syndrome of varying degrees of intensity in the chest area from the affected lung;
strong dry cough;
violation of heart rate, namely its increase;
decrease in blood tone;
cyanosis of the skin.

Similar symptoms are typical for both adults and children.

Diagnostics

To make the correct diagnosis, as well as to find out the localization and prevalence of the pathological process, is possible only with the help of instrumental examinations of the patient. However, before the implementation of such procedures, it is necessary that the pulmonologist independently carry out several manipulations.

Thus, the primary diagnosis will include:

study of the medical history and collection of the patient's life history - to identify the most likely etiological factor;
a thorough physical examination, including auscultation of the patient. In addition, it is necessary that the doctor assesses the condition of the skin, measures the pulse and blood pressure;
detailed interview of the patient - to obtain detailed information regarding the first time of onset and the severity of symptoms. This will allow the doctor to assess the severity of the course of the disease and its form, for example, atelectasis of the lower lobe of the right lung.

Laboratory studies are limited to the implementation of only blood biochemistry, which is necessary to study its gas composition. Such an analysis will show a decrease in the partial pressure of oxygen.

For the final confirmation of the diagnosis is carried out:

bronchoscopy - will help to accurately identify the cause of the appearance of such a disease;
X-ray - performed during inspiration. In this case, there will be a displacement of the organs of the mediastinal region towards the affected lung, and on exhalation - to the region of the healthy half;
bronchography and angiopulmonography - to assess the level of damage to the pulmonary-bronchial tree;
CT scan of the lungs - performed with dubious radiographic indicators and to clarify the localization of the pathology, in particular, to detect atelectasis of the upper lobe of the left lung or any other focus.

Treatment

After studying the results of all diagnostic measures, the clinician draws up an individual therapy strategy for each patient, taking into account the etiological factor.

Nevertheless, in almost all cases, conservative methods are sufficient. Thus, the treatment of lung atelectasis may include:

suction of exudate from the respiratory tract using a rubber catheter - this measure is indicated for patients with primary atelectasis. In some cases, newborns may need intubation or expansion of the lung with air;
therapeutic bronchoscopy - if the etiological factor was the presence of a foreign object;
bronchial lavage with antibacterial substances;
sanitation of the bronchial tree by endoscopic method - if the collapse of the lung is due to the accumulation of blood, pus or mucus. This procedure is called bronchoalveolar lavage;
tracheal aspiration - in cases where lung atelectasis was caused by previous surgery.

With a disease of any nature, patients are shown:

taking anti-inflammatory drugs;
performing breathing exercises;
passing a course of percussion massage;
postural drainage;
occupation of exercise therapy;
UHF and drug electrophoresis;
inhalation with bronchodilators or enzyme substances.

It is worth noting that patients are forbidden to treat the disease on their own with folk remedies, since this can only aggravate the problem and lead to the development of complications.

If conservative methods of therapy are ineffective in expanding the lung, they resort to surgical intervention - resection of the affected lung zone, for example, with atelectasis of the middle lobe of the right lung or other localization of the pathology.

Possible Complications

Lung atelectasis is a rather dangerous disease that can lead to the formation of such complications:

acute form;
accession of a secondary infectious process, which is fraught;
compression of the whole lung, which entails the death of the patient;
formation .

Prevention

Preventive measures to prevent the development of such a disease include the following rules:

maintaining a healthy and active lifestyle;
competent management of the recovery period after severe illnesses and operations on the bronchi or lungs;
taking medication strictly according to the prescription of the attending physician;
control of body weight so that it does not exceed the norm;
preventing the penetration of foreign objects into the bronchi;
regular passage of a complete preventive examination in a medical institution.

The prognosis of lung atelectasis directly depends on the cause that caused it and the timely treatment started. A severe course or a lightning-fast form of the disease very often leads to the appearance of complications, often leading to death.

When the alveoli fall off in the entire lung or in a certain area of it, they speak of lung atelectasis. The collapsed tissue does not participate in air exchange - this is accompanied by cyanosis of the skin, chest pain and shortness of breath.

Read about why such a condition develops, what are its symptoms and how to treat atelectasis in this publication.

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Atelectasis - what is it?

Atelectasis is a phenomenon in which the lung does not fully expand or does not fill with air at all (with a total lesion). As a result, the volume of respiration decreases, ventilation is disturbed in the alveoli.

In simple words, with atelectasis, the airiness of the lung decreases or completely disappears, it becomes like a deflated sticky ball that no longer inflates.

In the collapsed tissues, infectious pathologies quickly develop, and frequent consequences are:

Fibrosis - scarring of the lung due to the growth of connective tissue;
Bronchiectasis - irreversible expansion of part of the bronchus;
Lung abscess.

Causes of atelectasis:

Compression of a section of the bronchus from the outside - a cyst, a tumor, enlarged lymph nodes;
Blockage of the bronchial lumen from the inside - pathological fluid, foreign object, neoplasm;
Compression of tissues with liquid in case of exudative pleurisy or air in case of pneumothorax.

Atelectasis is a complication of many pulmonary diseases - tuberculosis, pneumonia and others, and can also be the result of trauma or surgery. Allergic pathologies, aortic aneurysm, neoplasms of the pleura and mediastinum can provoke the collapse of the alveolar tissue.

Atelectasis of the lobe of the lung in the upper part reduces the vital capacity of the lungs by 7-8%, the middle lobe - by 5%, and one of the lower lobes - by 20%.

Types of lung atelectasis, features

Lung atelectasis is divided into congenital and acquired, which are also called primary and secondary. In the first case, the alveolar tissue does not straighten out in a newborn child, and secondary atelectasis appears in the lung, which has already participated in air exchange.

There are types of atelectasis that are not associated with diseases or damage to the lungs:

Physiological - this is a temporary phenomenon of insufficient ventilation in some healthy people;
Intrauterine - airlessness of the lungs in the fetus is the norm.

According to the volume of the collapsed tissue, atelectasis can be lobular, acinous, segmental, lobar or total. One or both lungs can be affected. The most dangerous bilateral atelectasis - it often causes death.

Types of atelectasis by etiology:

Contraction develops due to compression of the fibrous tissue of the alveoli on the periphery of the lungs.
Discoid atelectasis of the lung - its cause is contusion of the chest, incomplete breathing due to pain (with intercostal neuralgia, pain in the heart, etc.), fracture of the ribs. In advanced cases, post-traumatic pneumonia develops.
Obstructive atelectasis occurs due to mechanical damage or blockage of the trachea and bronchi.
Acinar - appears due to a lack of surfactant, for example, in the case of respiratory distress syndrome.
Compression atelectasis, or collapse of the lung, develops if air or fluid accumulates in the pleural cavity, squeezing the organ from the outside.

The intensity of manifestations depends on how quickly the alveoli subside and on the volume of tissue involved in the process. In middle lobe syndrome, microatelectasis, and solitary segmental atelectasis, symptoms are most often absent.

With an acutely developing decline in a lobe or the entire lung, the symptoms are pronounced:

sharp pain in the chest on the affected side;
dyspnea;
decrease in blood pressure;
cyanosis of the skin and mucous membranes due to the accumulation of reduced hemoglobin in the tissues (cyanosis);
frequent pulse;
dry cough.

Without timely assistance, death can occur due to an increase in respiratory failure.

The progression of the condition is also fraught with the development of atelectatic pneumonia. Signs of inflammation are a wet cough, fever and symptoms of intoxication - weakness, dizziness, nausea, pressure drops.

Atelectasis in newborns - causes and symptoms

Physiological atelectasis can appear in premature newborns in the first days of life and resolves on its own without requiring medical intervention. However, the decline can also be caused by pathological factors.

Causes of atelectasis in newborns:

entry into the lungs of amniotic fluid, mucus, meconium;
lack of surfactant - a substance that prevents the collapse of the alveoli;
weak cry and insufficient breathing at birth;
pneumonia;
an increase in intrathoracic lymph nodes;
asphyxia;
congenital malformations of the lungs;
birth trauma of the skull, depressing the work of the respiratory center in the brain.

Symptoms progressive lung atelectasis in children:

Blueness or pallor of the skin;
Dyspnea;
Lack of breathing in the affected area when listening with a phonendoscope.

Diagnostics

In the diagnosis of atelectasis, use:

radiography;
fluoroscopy;
computed tomography;
bronchoscopy;
angiopulmonography (APG);
blood gas analysis.

Differential diagnosis is carried out to exclude interlobular pleurisy, cyst, cirrhosis of the lung, diaphragmatic hernia, pneumonia. Atelectasis is also important to distinguish from mediastinal swelling and diaphragmatic relaxation.

Tactics for the treatment of atelectasis

The main task in the treatment of lung atelectasis is to restore the patency of the bronchioles, bronchi and trachea, straighten the collapsed area and provide the body with a sufficient amount of oxygen.

For this, the following methods are used:

Postural drainage - the adoption by the patient of such a position of the body, in which the fluid that clogged the lumen of the bronchus leaves well. For example, if the right lung is affected, the person should be placed on the left side.
Bronchoscopy is the introduction of an apparatus into the bronchus, with the help of which it is examined from the inside and a foreign object or pathological fluid is removed from the lumen.
Medicines for thinning and better sputum discharge.
Antibiotic therapy to prevent or treat an underlying infectious disease.
With the help of chest massage, a better discharge of sputum, exudate or other liquid is achieved.
Breathing exercises.
Inhalations with oxygen, bronchodilators.
A pleural puncture, or drainage, is used if the lung is compressed by air or fluid that has accumulated in the pleural cavity.

Surgical intervention is indicated for rupture of the bronchus, cysts or malignant neoplasms, bronchiectasis, if it is impossible to straighten the lung with conservative methods.

Forecast

The prognosis of atelectasis depends on its cause and when treatment is started. With a timely visit to the doctor - no later than 1-2 days - it is favorable. Without treatment, secondary changes develop in the affected area of the lung, requiring longer and more complex therapy.

The risk of death is high with extensive and rapidly progressive atelectasis.

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Lung atelectasis (Greek atelēs incomplete, incomplete + ektasis stretching)

collapse of the entire lung or part of it due to impaired ventilation due to obstruction of the bronchus or compression of the lung. Accordingly, there are obstructive and compression A. l. With obstruction of the main bronchus, the entire lung occurs, with a violation of the patency of the lobar or segmental bronchi - atelectasis of the corresponding pulmonary lobes and segments. Bronchial obstruction 4 - 6th order can lead to a collapse of part of the lung segment - subsegmental atelectasis. Discoid atelectasis is formed as a result of the collapse of several adjacent lung lobes, which often occurs with diffuse lesions of the bronchopulmonary system (pneumonitis, fibrosing alveolitis, sarcoidosis). With obstruction of the terminal and respiratory bronchioles, lobular atelectasis is formed. bronchus can be caused by a foreign body, viscous sputum, blood, vomit, tumor. Less often A. l. due to ruptures of the bronchi in various injuries, cicatricial narrowing of the bronchi as a result of injuries or tuberculosis, as well as compression of the bronchi from the outside by various intrathoracic tumors, cysts, accumulations of air and fluid in pneumothorax, pleurisy. Occasionally, the so-called reflex atelectasis is noted, the cause of which may be the bronchi with the closure of their lumen.

The clinical picture largely depends on how much lung tissue is turned off from ventilation and how quickly it stops. The most pronounced manifestations are characterized by rapidly emerging atelectasis of the entire lung. for example, when the bronchi are blocked with thick mucus in the postoperative period, it occurs, becomes more frequent, sometimes appears. Progressive respiratory failure can be fatal. The chest wall on the atelectasis side noticeably lags behind in respiratory movements compared to the healthy side. On percussion, it is determined dull, on auscultation it is absent. shifts towards the atelectatic lung (this can be determined by the localization of the apex beat, as well as by percussion and auscultation of the heart). With atelectasis of a lobe or segment of the lung, clinical manifestations are less pronounced, and sometimes absent altogether. Identify A. l. in such cases, it is possible only with an X-ray examination, which is the most reliable method for diagnosing this pathological condition.

For detection A. l. use multi-axis fluoroscopy of the chest, radiography in direct and lateral projections, tomography (including computer). X-ray picture A. l. varied and depends on the volume of the collapsed part of the lung. The main symptom of A. l . is the shading of all or part of the lung field. In the first hours after blockage of the bronchus, the shadow of the collapsed lung is heterogeneous, because some of the lobules are still contained. In the future, the shading becomes homogeneous, against its background, the gaps of the bronchi are not visible, as is the case with inflammatory infiltration. Another symptom of A. l. is the coincidence of shading with the boundaries of the whole lung, its lobe, segment. In connection with a decrease in the volume of the collapsed lung tissue, adjacent parts of the lung increase and move, sometimes the position of the ribs, diaphragm, and mediastinal organs changes. With atelectasis of the entire lung, the corresponding half of the chest is narrowed, an intense and uniform shading of the entire lung field is determined, the pulmonary pattern is not traced ( rice. 1 ). On the tomograms, it is revealed that the air fills only the main one to the place of its blockage. The mediastinal organs are constricted towards atelectasis. on the side of the lesion is raised, it is sharply weakened. The opposite half of the chest is expanded, the transparency of the lung field is increased, and is actively involved in breathing. When fluoroscopy reveals signs of impaired bronchial patency - the displacement of the mediastinal organs during inhalation towards atelectasis, and during exhalation and coughing - in the opposite direction.

With atelectasis of the lobe of the lung, its shadow is reduced in volume, intense and uniform ( rice. 2 ), the interlobar border is retracted towards atelectasis and clearly delimits it from neighboring lobes. Adjacent areas of the lung on radiographs appear lighter, and the vessels in them are moved apart. Shading always starts from the root of the lung, and adjoins the outer side to the border of the lung field. With atelectasis of the upper lobe, there is a slight pulling of the upper mediastinum, and with atelectasis of the lower lobe - of the lower mediastinum.

With segmental atelectasis, intense shading of a triangular or trapezoidal shape is noted, with one end facing the root of the lung ( rice. 3 ). With atelectasis of the basal segments, the rise of the adjacent parts of the diaphragm is determined. Subsegmental atelectasis on radiographs has a strip running from the site of bronchus obstruction to the border of the lobe. Unlike the shadow of a blood vessel, this strip does not narrow towards the periphery, does not give branches, and retains a linear appearance on images in different projections. At the edge of the lung field, the strip expands, acquiring the shape of a bell, which corresponds to a funnel-shaped retraction on the surface of the lung. Discoid atelectasis has the appearance of a narrow horizontal strip, often located in the cortical regions of the lungs ( rice. 4 ).

Lobular atelectasis on radiographs are rounded or polygonal shadows with a diameter of 0.5-1 cm, differing from pneumonic foci in the speed of appearance and disappearance, the uniformity of shape and size, the presence of disc-shaped atelectasis in the neighborhood,

X-ray examination allows not only to identify A. l., but also to carry out differential with a tumor of the mediastinum, interlobar pleurisy, with multiple small atelectasis - with congestion in the pulmonary circulation. In some cases, with the help of X-ray examination, it is possible to establish the cause of A. l. (e.g. bronchus, tuberculosis). In order to clarify the cause of bronchoconstriction, bronchoscopy and computed tomography are performed.

Treatment is carried out in a hospital. In order to restore bronchial patency during obstruction of the bronchi with foreign bodies or liquid masses (sputum, blood), bronchoscopy is performed. In less severe cases, you can try to aspirate sputum through the introduced into the bronchus. Essential for this procedure is stimulated by irritation of the bronchial mucosa. With atelectasis caused by cicatricial stenosis of the bronchi, tumors, cysts, as a rule, it is necessary. In cases of compression A. l., caused by pleurisy or pneumothorax, pleural punctures and pleural cavity with aspiration of fluid and air are effective.

The prognosis depends to a large extent on the rate at which ventilation ceases. In the zone of atelectasis, with a slow, gradual closure of the lumen of the bronchus, an inflammatory process develops - atelectatic. In the future, as the inflammatory process subsides, it forms, irreversible sclerotic changes progress (). The respiratory system of the affected area of the lung is lost. If atelectasis occurs acutely, within a short time, the bronchi are filled with thick and, as a rule, sterile mucus. Inflammatory and sclerotic changes in such cases are usually minimal, and after the elimination of the cause of atelectasis, the lung can again perform a gas exchange function.

Prevention A. l. is especially important after operations on the organs of the chest. must breathe deeply enough. It is important to explain to him that in order to maintain a free airway, it is necessary to cough well. It is necessary to periodically change the position of the patient in bed, activate it as early as possible, carry out chest, breathing exercises.

Features of lung atelectasis in children. In newborns, especially often in premature babies, so-called congenital, or primary, A. l., associated with non-expansion of the lung after birth, can be observed. In their occurrence, the immaturity of the lung tissue plays an important role: poor development of elastic fibers, insufficient surfactant. surfactant can decrease sharply as a result of severe oxygen deficiency, metabolic acidosis, which leads to the development of A. l. in some diseases (for example, pneumonia) in mature full-term newborns, as well as in older children. may be associated with aspiration of amniotic fluid (for example, with fetal hypoxia, asphyxia of the newborn, cerebrovascular accident). food is more often observed in children with malformations (non-closure of the soft and hard palate, tracheoesophageal) or neurological disorders (soft palate). In children, especially at an early age, more often than in adults, there are A. l., due to blockage of the bronchi with mucus in acute bronchitis, bronchopneumonia, primary tuberculosis complex, bronchial asthma, which is associated with the narrowness of the bronchial lumen, weakness of the cough impulse. Frequent development of A. l. in cystic fibrosis, it is due to the high viscosity of sputum, the formation of dense plugs that close the lumen of the bronchus.

Clinical picture A. l. virtually indistinguishable from that of adults. With atelectasis of the entire lung, its lobe or several segments, children experience shortness of breath, cough, retraction of the intercostal spaces on the side during breathing, and in newborns, retraction of the sternum, resembling a congenital funnel-shaped deformity; with concomitant pneumonia, they can be heard from other segments of the lung.

With multiple subsegmental and lobular atelectasis resulting from low surfactant activity in newborns, or when aspiration of liquid or mushy food that enters the small bronchi when coughing (which may also occur in older children), symptoms of respiratory failure (shortness of breath, pallor, cyanosis of the nasolabial triangle, or general cyanosis). On physical examination, a boxed tone of percussion sound is determined, weakened, with deep breathing, crepitating and various wet rales are heard. Disorders of the cardiovascular system (acute pulmonary) are expressed.

On x-ray examination, atelectasis of the whole lung is accompanied by more pronounced signs of bronchial obstruction than in adults. At A. l. in newborns associated with non-expansion of the lung after birth, shading and a decrease in the size of the lung field (usually the left one) are determined on radiographs, but large air-filled bronchi are usually traced. allows children to differentiate A. l. with lung hypoplasia, thymomegaly.

Treatment A. l. carried out according to the same principles as in adults. Treatment A. l. in newborns due to a decrease in surfactant activity - see Neonatal Distress Syndrome (Respiratory Distress Syndrome of the Newborn) .

A child who has undergone A. l. should be under dispensary observation in a clinic for at least a year. During the rehabilitation period, a general strengthening, vibration massage of the chest, therapeutic exercises, iodine or magnesium preparations, aminofillin (inside 5-7 mg/kg per day), which has an antispasmodic effect and improves in the lung. Children over 3 years of age are shown sanatorium treatment.

Bibliography: Respiratory diseases in children, ed. S.V. Rachinsky and V.K. Tatochenko, p. 90, M., 1987; Lindenbraten L.D. and Naumov L.B. X-ray syndromes and lung diseases, M., 1972; Rozenshtraukh L.S., Rybakova N.I. and Vinner M.G. respiratory diseases, M., 1987; Guide to pulmonology, ed. N.V. Putov and G.B. Fedoseeva, p. 43, L., 1978; Handbook of pulmonology, ed. N.V. Putova and others, p. 18, L., 1988.

Chest radiograph (right lateral projection) with atelectasis of the IV segment of the right lung: intense shading in the form of a triangle, apex facing the root of the lung "\u003e

Rice. 3. X-ray of the chest (right lateral projection) with atelectasis of the IV segment of the right lung: intense shading in the form of a triangle, apex facing the root of the lung.

the share of the right lung is reduced in volume, homogeneously shaded">

Rice. 2b). Chest radiograph with atelectasis of the upper lobe of the right lung (right lateral view): the upper lobe of the right lung is reduced in volume, homogeneously shaded.

Atelectasis of the lung is a disease associated with the loss of airiness of the lung tissue. It is formed in connection with the influence of internal factors. It can capture the respiratory organ completely or be limited to part of it. At the same time, alveolar ventilation is disturbed, the respiratory surface decreases, and signs of oxygen starvation appear. In the collapsed part of the lung, conditions are created for the development of inflammatory processes, fibrosis, bronchiectasis. Arising complications may require surgical intervention when it is necessary to remove the atelectatic area.

The collapse of the respiratory organ is also caused by external causes. This happens, for example, during mechanical compression. In this case, the disease is called lung collapse.

Classification

There are several types of atelectasis syndrome. By origin, it is divided into primary and secondary. The first is diagnosed at the birth of a child, when the lung does not fully expand during the first breath. The secondary form is formed as a complication after suffering inflammatory diseases.

According to the mechanism of occurrence, several types of atelectasis are distinguished:

Obstructive. It is formed when the lumen of the bronchus decreases due to an obstacle in the form of a foreign body, a clot of mucus, a tumor. The main symptoms are shortness of breath, dry cough, difficulty breathing. There are both complete and partial collapse of the lung. Urgent action is needed to restore air permeability in the bronchi. With each hour, the likelihood that the respiratory organ will be able to crack down completely decreases. After 3 days, restoration of ventilation becomes impossible. The development of pneumonia in such conditions is a frequent occurrence in this type of atelectasis.

Compression. Has a more favorable prognosis. Even after a long period of compression of the lung tissue, ventilation can be fully restored. This type of disease occurs with the appearance in the pleural cavity of an abnormal volume of inflammatory fluid, which leads to compression of the lung tissue. Symptoms increase gradually. They manifest as mixed shortness of breath, when both inhalation and exhalation are difficult.
Distension (functional). Formed in the lower lobes. The type of disease is associated with a violation of the respiratory mechanism. Patients who are on prolonged bed rest are most susceptible to it. Pathology occurs when trying to limit respiratory movements due to pain associated with a fracture of the ribs or pleurisy. Lung atelectasis caused by a stroke is called contractile.
Contractual. It is formed as a result of the growth of connective tissue, leading to compression of the pleural cavity and adjacent departments.

Separately, it is worth highlighting the atelectasis of the middle lobe of the right lung. The middle lobe bronchus, being the longest, is most prone to blockage. The disease is characterized by a cough with sputum, accompanied by fever and wheezing. The disease is especially acute when the upper lobe of the right lung is affected.

Replacement of the collapsed connective tissue is called fibroatelectasis.

In some medical sources, the contractile form of this disease is distinguished, when the size of the alveoli decreases, and with spasms of the bronchus or trauma, surface tension forms.

The following types of atelectasis are distinguished from the level of blockage of the bronchi, which X-ray detects:

Discoid, when several lobes are compressed.
subsegmental atelectasis. May lead to complete obturation in the left or right lung.
Linear.

According to the International Classification of Diseases, atelectasis is assigned the code J98.1.

Causes of the disease

Congenital atelectasis is associated with the penetration of amniotic fluid, mucus, meconium into the respiratory organs. Its development is facilitated by intracranial trauma received during childbirth.

Among the common causes of acquired atelectasis or collapse, it is worth highlighting:

Prolonged compression of the respiratory organ from the outside.
Allergic reactions.
Obstruction of the lumen of one or more bronchi.
The presence of neoplasms of a different nature, leading to compression of the lung tissue.
Blockage of the bronchus by a foreign object.
The accumulation of mucus in large volumes can lead to atelectasis.
Among the causes of fibroatelectasis are pleuropneumonia, tuberculosis.

In addition, lung atelectasis is often provoked by various factors, including:

Respiratory diseases - pneumothorax, exudative pleurisy, hemothorax, chylothorax, pyothorax.
Prolonged bed rest.
Rib fracture.
Uncontrolled intake of drugs.
Overweight.
Smoking.

There is an increased risk of atelectasis in people over the age of 60, as well as babies who are under 3 years old.

Symptoms

Vivid symptoms manifest themselves depending on how much lung volume the pathological process extends to. With the defeat of one segment, pulmonary pathology can be almost asymptomatic. Only X-ray helps to detect it at this stage. The most pronounced manifestation of the disease is observed with atelectasis of the upper lobe of the right lung. When the middle lobe is affected, examination reveals diaphragmatic elevation.

The main symptoms of the disease when several parts fall off:

Shortness of breath that occurs both during physical activity and at rest.
Painful sensations. With the defeat of the right lung - on the right side, and vice versa.
Increased heart rate.
Decreased blood tone.
Dry cough.
Cyanosis.

The listed symptoms are equally characteristic for adult patients and for children.

Video

Video - What to do with lung atelectasis

Diagnostics

Primary diagnosis includes taking an anamnesis, physical examination, assessment of the condition of the skin, measurement of pulse and blood pressure.

The main method to diagnose what it is lung atelectasis syndrome is x-ray. X-ray shows signs of lung tissue collapse.

These include:

Eclipse of a homogeneous nature in the affected area. Its size and shape can be different and depend on the type of disease. An extensive eclipse, detected on x-ray, indicates lobar atelectasis of the lung, a sign of subsegmental eclipse, resembling a triangle or wedge. The distension is located in the lower part of the respiratory organ, closer to the diaphragm.
displacement of organs. Due to the pressure exerted by the affected side, with compression atelectasis, the mediastinal organs located between the lungs are shifted to the healthy side. For obturation, on the contrary - with the defeat of the right lung, a shift to the right is characteristic, the left - to the left.

X-ray helps to detect where the organs are shifted during breathing and during coughing. This is another factor that determines the type of disease.

Sometimes X-rays have to be supplemented with computed tomography, bronchoscopy. How affected the lungs, the degree of deformation of the bronchi, the state of the vessels is determined by bronchography, angiopulmonography.

Treatment Methods

When atelectasis is detected in newborns, the airways are cleansed by sucking the contents with a catheter. Sometimes artificial ventilation is required.

The treatment regimen for lung atelectasis of the secondary form is compiled for each patient individually, taking into account the etiological factor.

Conservative methods include:

Therapeutic bronchoscopy to eliminate bronchial obstruction, when the cause of the disease is the presence of a foreign object or a lump of mucus.

Washing with antibacterial agents.
Bronchoalveolar lavage - sanitation of the bronchi by endoscopic method. It is carried out with the accumulation of a large amount of blood or pus.
tracheal aspiration.
postural drainage. When atelectasis is localized in the upper sections, the patient is given an elevated position, if in the lower ones - on the side with the side lowered in the opposite direction from the affected lung. It can be either the right side or the left side.

Regardless of the nature of the disease, the patient is prescribed anti-inflammatory drugs, breathing exercises, percussion massage, a light exercise therapy complex, and physiotherapy.

You can not self-medicate, trying to eliminate atelectasis by means of traditional medicine. Delayed seeking medical help complicates and prolongs the treatment process. If conservative methods do not give a positive result, one has to resort to surgical intervention, in which the affected part of the lung is removed.

Prevention

You can prevent the occurrence of atelectasis of any kind if you follow the following rules:

Stick to a healthy lifestyle.
In the recovery period after suffering bronchopulmonary diseases, follow all the doctor's recommendations.
Control your weight.
Do not take medications without a doctor's prescription.
Get checked regularly for prevention.

The success of treatment depends on the cause that caused atelectasis, and timely measures taken. The mild form of the disease is cured quickly.

With a severe course of the disease, as well as with its fulminant form, complications often occur, sometimes leading to death.