Introduction:

When there is a thick mucous plug in the bronchial tubes, the air behind the plug in the alveoli gets absorbed and the lung tissue collapses. When this happens, there is only a finite time (1 to 3 days) to reexpand the lung, otherwise it can get infected and could possibly stay permanently collapsed.

Symptoms:

With the right lower lung lobe a partial or complete collapse (=atelectasis) might feel to the patient like an acute abdominal pain in the right upper abdomen.

This is due to referred pain as the diaphragm, which divides the chest cavity from the abdominal cavity, can get irritated. However, the majority of symptoms will be in the chest cavity with shortness of breath, painful breathing (=dyspnea) and bluish skin discoloration, called cyanosis. There might also be a fever, a fast heart beat and a drop in blood pressure. The physician notices on examination that the chest wall movements are reduced at the involved side when compared to the other side. On auscultation (=exam with the stethoscope) the physician cannot hear the breath sounds over the collapsed lung tissue. With percussion there is a dullness over the area. Chest X-rays will confirm the diagnosis of atelectasis. Atelectases can develop following surgery, particularly after surgery in the upper abdomen or of the stomach. Unconscious patients develop a collapsed lung easily.

Treatment:

In an unconscious patient frequent suctioning of the tenacious secretions under sterile conditions will prevent atelectases and is also the therapy when it has occurred. If there was aspiration of a foreign body, bronchoscopy has to be done by a lung specialist (=respirologist). This involves inserting a fiberoptic instrument (the bronchoscope) through the trachea into the bronchial tubes identifying the foreign body and extracting it. The patient who has an atelectasis, needs to be placed in a way that the the atelectasis is on top to facilitate "postural drainage". This is combined with aggressive chest physiotherapy and the patient is encouraged to cough frequently to re-expand the collapsed lung tissue. Deep breathing exercises are also part of the therapy. If an infection is present at the same time broad spectrum antibiotic coverage is also given.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. DM Thompson: The 46th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems".

6. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:"Abdominal pain".

7. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".

8. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

Last Modified: Dec. 28, 2008