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Atelectasis

Definition:
  • Atelectasis refers to the partial or complete collapse of a part or the whole of the lung. It results from a reduction or absence of air in the alveoli.
Epidemiology:
  • Commonly seen in post-operative patients, especially after thoracic or upper abdominal surgery.
  • Can also occur in individuals of any age with various respiratory conditions.
Aetiology:
  • Obstructive (due to blockage):
    • Mucus plug
    • Tumour
    • Foreign body
  • Non-obstructive:
    • Pleural effusion
    • Pneumothorax
    • Pulmonary oedema
    • Chest wall or pleural disease
    • Positional (e.g., bed-bound patients)
    • Reduced surfactant production (common in neonates)
Clinical Features:
  • Symptoms can be absent in small areas of atelectasis.
  • Dyspnoea (difficulty breathing)
  • Pleuritic chest pain
  • Cough
  • Increased respiratory rate
Investigations:
  • Chest X-ray: Areas of increased opacity; volume loss may be indicated by shift of the mediastinum, hemidiaphragm, or fissures towards the collapsed area.
  • CT scan: Better resolution, especially for subtle or loculated atelectasis.
  • Bronchoscopy: Useful for suspected obstructive causes like mucus plugs or tumours.
Management:
  • Address the underlying cause.
  • Physiotherapy:
    • Chest percussion
    • Deep breathing exercises
    • Incentive spirometry
  • Positioning: Encourage post-operative patients to sit up and mobilise.
  • Bronchodilators: For those with underlying reactive airway diseases.
  • Supplemental Oxygen: To treat hypoxia if present.
Complications:
  • Pneumonia: Due to pooled secretions behind the obstruction.
  • Respiratory failure: If extensive atelectasis or in combination with other lung diseases.

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