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{{Atelectasis}}
{{Atelectasis}}
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==Overview==
==Overview==
Atelectasis may be an acute or chronic condition. In acute atelectasis, the lung has recently collapsed and is primarily notable only for airlessness. In chronic atelectasis, the affected area is often characterized by a complex mixture of airlessness, infection, widening of the bronchi ([[bronchiectasis]]), destruction, and scarring (fibrosis).
[[Atelectasis]] may be classified based on etiology into [[Obstruction|obstructive]] and non-obstructive types. Obstructive atelectasis, is the most common type of atelectasis  which may develop due to [[obstruction]] by [[foreign bodies]], [[Tumor|tumors]] and mucus plugs. Atelectasis may also be classified based on duration of symptoms into acute and chronic types. Acute atelectasis is associated with airlessness due to recent lung collapse while chronic atelectasis involves a combination of [[infection]], [[Bronchiole|bronchial]] destruction, and [[fibrosis]], in adition to airlessness.


==Classification==
==Classification==
===Acute Atelectasis===
Acute atelectasis is a common postoperative complication, especially after chest or abdominal surgery. Acute atelectasis may also occur with an injury, usually to the chest (such as that caused by a car accident, a fall, or a stabbing). Atelectasis following surgery or injury, sometimes described as massive, involves most alveoli in one or more regions of the lungs. In these circumstances, the degree of collapse among alveoli tends to be quite consistent and complete. Large doses of opioids or sedatives, tight bandages, chest or abdominal pain, abdominal swelling (distention), and immobility of the body increase the risk of acute atelectasis following surgery or injury, or even spontaneously. 


In acute atelectasis that occurs because of a deficiency in the amount or effectiveness of surfactant, many but not all alveoli collapse, and the degree of collapse is not uniform. Atelectasis in these circumstances may be limited to only a portion of one lung, or it may be present throughout both lungs. When premature babies are born with surfactant deficiency, they always develop acute atelectasis that progresses to neonatal respiratory distress syndrome.Adults can also develop acute atelectasis from excessive oxygen therapy and from mechanical ventilation, because of decreased effectiveness of surfactant.
[[Atelectasis]] may be classified based on etiology into [[Obstruction|obstructive]] and non-obstructive types.  


===Chronic Atelectasis===
=== Based on Etiology ===
Chronic atelectasis may take one of two forms—middle lobe syndrome or rounded atelectasis. In middle lobe syndrome, the middle lobe of the right lung contracts, usually because of pressure on the bronchus from enlarged [[lymph]] glands and occasionally a [[tumor]]. The blocked, contracted lung may develop [[pneumonia]] that fails to resolve completely and leads to chronic inflammation, scarring, and [[bronchiectasis]].


In rounded atelectasis (folded lung syndrome), an outer portion of the lung slowly collapses as a result of scarring and shrinkage of the membrane layers covering the lungs (pleura). This produces a rounded appearance on [[x-ray]] that doctors may mistake for a tumor. Rounded atelectasis is usually a complication of [[asbestos]]-induced disease of the pleura, but it may also result from other types of chronic scarring and thickening of the pleura.
==== Obstructive atelectasis ====
* Obstructive atelectasis, which is the most common type of atelectasis may develop due to [[obstruction]] by [[foreign bodies]], [[Tumor|tumors]] and mucus plugs. 
* In case of obstruction from the [[Tracheal bronchus|trachea]] to the [[Pulmonary alveolus|alveoli]] at any level, [[Alveolus|alveolar]] gas reabsorption may occur leading to subsequent atelectasis.<ref name="urlAtelectasis - Symptoms and causes - Mayo Clinic">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/atelectasis/symptoms-causes/syc-20369684 |title=Atelectasis - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref> 
* Middle lobe syndrome (fixed or recurrent atelectasis of the [[lingula]]/ right middle lobe) may occur due to [[Sjögren's syndrome|Sjogren’s syndrome]]. Intraluminal or extraluminal [[obstruction]] (compression of the [[Bronchus|bronchi]] by adjacent structures) may result in middle lobe syndrome.<ref name="pmid16548837">{{cite journal |vauthors=Chen HA, Lai SL, Kwang WK, Liu JC, Chen CH, Huang DF |title=Middle lobe syndrome as the pulmonary manifestation of primary Sjögren's syndrome |journal=Med. J. Aust. |volume=184 |issue=6 |pages=294–5 |year=2006 |pmid=16548837 |doi= |url=}}</ref><ref name="pmid6611925">{{cite journal |vauthors=Rosenbloom SA, Ravin CE, Putman CE, Sealy WC, Vock P, Clark TJ, Godwin JD, Chen JT, Baber C |title=Peripheral middle lobe syndrome |journal=Radiology |volume=149 |issue=1 |pages=17–21 |year=1983 |pmid=6611925 |doi=10.1148/radiology.149.1.6611925 |url=}}</ref>


There are several types of atelectasis according to their underlying mechanisms or the distribution of alveolar collapse; resorption, compression, microatelectasis and contraction atelectasis.
==== Non-obstructive atelectasis ====
* Non obstructive atelectasis may occur due to the following reasons:<ref name="urlAtelectasis - Symptoms and causes - Mayo Clinic">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/atelectasis/symptoms-causes/syc-20369684 |title=Atelectasis - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref><ref name="urlAtelectasis | Causes, Symptoms, Treatment & Prevention">{{cite web |url=http://www.innerbody.com/diseases-conditions/atelectasis |title=Atelectasis &#124; Causes, Symptoms, Treatment & Prevention |format= |work= |accessdate=}}</ref>
** Severe lung scarring caused by necrotizing [[pneumonia]] or [[Sarcoidosis|granulomatous diseases]]: Cicatrisation atelectasis
** [[Lung]] infiltration: Replacement atelectasis
** Extrinsic lung compression: Due to thoracic space occupying lesions
** Diminished levels of [[Pulmonary surfactant|surfactant]]: Adhesive atelectasis presenting as [[Acute respiratory distress syndrome|ARDS]]
** Absence of contact between the [[Parietal pleura|parietal]] and [[Visceral pleura|visceral pleurae]] due to fluid ([[pleural effusion]]), air ([[pneumothorax]]), blood ([[hemothorax]]): Passive atelectasis
** Formation of fibrous bands which adhere the [[lung]] to the [[Pleural cavity|pleura]] in patients with [[asbestosis]]: Rounded atelectasis
** Complication of [[surgery]] or [[Anesthesia|anaesthesia]] leading to decreased surfactant activity and dysfunction of the [[Thoracic diaphragm|diaphragm]]: Postoperative atelectasis


=== Based on Duration  ===
Atelectasis may also be classified based on duration of symptoms into acute and chronic types.
====Acute Atelectasis====
* Acute atelectasis is associated with airlessness due to recent [[lung]] collapse. 
* Acute atelectasis includes postoperative atelectasis, after thoracic or abdominal surgery, chest trauma, and rib fractures. Surfactant deficiency, excessive oxygen therapy and mechanical ventilation may lead to acute atelectasis. 
====Chronic Atelectasis====
* Chronic atelectasis is not only associated with airlessness, but a combination of [[infection]], bronchial destruction, widening and [[fibrosis]] leading to [[scarring]].
* Middle lobe syndrome and rounded atelectasis are causes of chronic atelectasis.
* '''Middle lobe syndrome''' (fixed or recurrent atelectasis of the [[lingula]]/ right middle lobe) may occur due to [[Sjögren's syndrome|Sjogren’s syndrome]]. Intraluminal or extraluminal [[obstruction]] (compression of the [[Bronchus|bronchi]] by adjacent structures) may result in middle lobe syndrome.<ref name="pmid165488372">{{cite journal |vauthors=Chen HA, Lai SL, Kwang WK, Liu JC, Chen CH, Huang DF |title=Middle lobe syndrome as the pulmonary manifestation of primary Sjögren's syndrome |journal=Med. J. Aust. |volume=184 |issue=6 |pages=294–5 |year=2006 |pmid=16548837 |doi= |url=}}</ref><ref name="pmid66119252">{{cite journal |vauthors=Rosenbloom SA, Ravin CE, Putman CE, Sealy WC, Vock P, Clark TJ, Godwin JD, Chen JT, Baber C |title=Peripheral middle lobe syndrome |journal=Radiology |volume=149 |issue=1 |pages=17–21 |year=1983 |pmid=6611925 |doi=10.1148/radiology.149.1.6611925 |url=}}</ref>
* '''Rounded atelectasis''' is characterized by the formation of fibrous bands which adhere the [[lung]] to the [[Pleural cavity|pleura]] in patients with [[asbestosis]].
==References==
==References==
{{reflist|2}}
{{Reflist|2}}


[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Signs and symptoms]]
[[Category:Radiology]]
[[Category:Radiology]]
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Latest revision as of 16:53, 26 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Atelectasis may be classified based on etiology into obstructive and non-obstructive types. Obstructive atelectasis, is the most common type of atelectasis which may develop due to obstruction by foreign bodies, tumors and mucus plugs. Atelectasis may also be classified based on duration of symptoms into acute and chronic types. Acute atelectasis is associated with airlessness due to recent lung collapse while chronic atelectasis involves a combination of infection, bronchial destruction, and fibrosis, in adition to airlessness.

Classification

Atelectasis may be classified based on etiology into obstructive and non-obstructive types.

Based on Etiology

Obstructive atelectasis

  • Obstructive atelectasis, which is the most common type of atelectasis may develop due to obstruction by foreign bodies, tumors and mucus plugs.
  • In case of obstruction from the trachea to the alveoli at any level, alveolar gas reabsorption may occur leading to subsequent atelectasis.[1]
  • Middle lobe syndrome (fixed or recurrent atelectasis of the lingula/ right middle lobe) may occur due to Sjogren’s syndrome. Intraluminal or extraluminal obstruction (compression of the bronchi by adjacent structures) may result in middle lobe syndrome.[2][3]

Non-obstructive atelectasis

Based on Duration

Atelectasis may also be classified based on duration of symptoms into acute and chronic types.

Acute Atelectasis

  • Acute atelectasis is associated with airlessness due to recent lung collapse.
  • Acute atelectasis includes postoperative atelectasis, after thoracic or abdominal surgery, chest trauma, and rib fractures. Surfactant deficiency, excessive oxygen therapy and mechanical ventilation may lead to acute atelectasis.

Chronic Atelectasis

  • Chronic atelectasis is not only associated with airlessness, but a combination of infection, bronchial destruction, widening and fibrosis leading to scarring.
  • Middle lobe syndrome and rounded atelectasis are causes of chronic atelectasis.
  • Middle lobe syndrome (fixed or recurrent atelectasis of the lingula/ right middle lobe) may occur due to Sjogren’s syndrome. Intraluminal or extraluminal obstruction (compression of the bronchi by adjacent structures) may result in middle lobe syndrome.[5][6]
  • Rounded atelectasis is characterized by the formation of fibrous bands which adhere the lung to the pleura in patients with asbestosis.

References

  1. ↑ 1.0 1.1 "Atelectasis - Symptoms and causes - Mayo Clinic".
  2. ↑ Chen HA, Lai SL, Kwang WK, Liu JC, Chen CH, Huang DF (2006). "Middle lobe syndrome as the pulmonary manifestation of primary Sjögren's syndrome". Med. J. Aust. 184 (6): 294–5. PMID 16548837.
  3. ↑ Rosenbloom SA, Ravin CE, Putman CE, Sealy WC, Vock P, Clark TJ, Godwin JD, Chen JT, Baber C (1983). "Peripheral middle lobe syndrome". Radiology. 149 (1): 17–21. doi:10.1148/radiology.149.1.6611925. PMID 6611925.
  4. ↑ "Atelectasis | Causes, Symptoms, Treatment & Prevention".
  5. ↑ Chen HA, Lai SL, Kwang WK, Liu JC, Chen CH, Huang DF (2006). "Middle lobe syndrome as the pulmonary manifestation of primary Sjögren's syndrome". Med. J. Aust. 184 (6): 294–5. PMID 16548837.
  6. ↑ Rosenbloom SA, Ravin CE, Putman CE, Sealy WC, Vock P, Clark TJ, Godwin JD, Chen JT, Baber C (1983). "Peripheral middle lobe syndrome". Radiology. 149 (1): 17–21. doi:10.1148/radiology.149.1.6611925. PMID 6611925.

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