Atelectasis
Basics
Description
- State of collapsed and airless alveoli
- May be subsegmental, segmental, or lobar or may involve the entire lung
- A radiographic sign of an underlying disease and not a diagnosis unto itself
Epidemiology
- Depends on the underlying disease causing atelectasis
- Resorption atelectasis is the most common form.
Risk Factors
Genetics
Depends on the underlying disease causing atelectasis (i.e., cystic fibrosis, primary ciliary dyskinesia)
General Prevention
- Maintaining adequate cough
- Good airway clearance techniques in patients at risk for atelectasis
Pathophysiology
- Reduced lung compliance
- Loss of alveoli (if extensive) may lead to hypoxia.
- Intrapulmonary shunting develops from hypoxia-induced pulmonary arterial vasoconstriction, which may lead to areas of ventilation–perfusion (V/Q) mismatch and further hypoxia.
- If atelectasis is extensive and long-term, pulmonary hypertension may develop.
- Atelectatic areas are prone to bacterial overgrowth and possible secondary infection.
Etiology
- Airway obstruction (resorption atelectasis)
- Most common cause of atelectasis in children
- Obstructed communication between alveoli and trachea
- Large airway obstruction
- Intrinsic
- Foreign body aspiration
- Mucous plug
- Tumor
- Plastic bronchitis
- Extrinsic
- Hilar adenopathy
- Mediastinal mass
- Congenital lung malformations
- Intrinsic
- Small airway obstruction
- Acute infection
- Bronchiolitis
- Pneumonia
- Respiratory infections are the most common cause of acute atelectasis.
- Altered mucociliary clearance:
- CNS depression
- Smoke inhalation
- Pain
- Acute infection
- Mechanical compression of the pulmonary parenchyma or pleural space (compressive atelectasis)
- Intrathoracic compression
- Pneumothorax
- Pleural effusion
- Lobar emphysema
- Intrathoracic tumors
- Cardiomegaly
- Diaphragmatic hernias
- Abdominal distention
- Large intra-abdominal tumors
- Hepatosplenomegaly
- Massive ascites
- Morbid obesity
- Intrathoracic compression
- Decreased surface tension in the small airways and alveoli (adhesive atelectasis)
- Stems from surfactant deficiency
- Diffuse surfactant deficiency
- Hyaline membrane disease
- Acute respiratory distress syndrome
- Smoke inhalation
- Localized surfactant deficiency
- Acute radiation pneumonitis
- Pulmonary embolism
- Neuromuscular weakness (hypoventilation)
- Inherent weakness
- Duchenne muscular dystrophy
- Spinal muscular atrophy
- Paralysis
- Acquired weakness (e.g., postanesthesia hypoventilation)
- Inherent weakness
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Citation
Cabana, Michael D., editor. "Atelectasis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617601/all/Atelectasis.
Atelectasis. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617601/all/Atelectasis. Accessed December 12, 2024.
Atelectasis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617601/all/Atelectasis
Atelectasis [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 December 12]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617601/all/Atelectasis.
* Article titles in AMA citation format should be in sentence-case
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