Atelectasis
Updated on All content is checked by medical journalists.Atelectasis is a vacuum in the lung tissue. It is not an independent clinical picture, but rather a condition that arises as a result of another underlying disease. Atelectasis affects the entire lung or - more often - only circumscribed sections of the lung. Learn how atelectasis can develop and how it is treated.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J98
Atelectasis: description
With atelectasis, parts of the lungs or the entire lungs are evacuated. The term comes from the Greek and means something like "incomplete expansion".
The condition primarily affects the smallest air-carrying units of the lungs, the alveoli. They are surrounded by a fine network of tiny blood vessels and have a very important function - gas exchange takes place in the alveoli (absorption of oxygen from the inhaled air into the blood, release of carbon dioxide from the blood into the air, which is then exhaled).
In the case of atelectasis, air can no longer enter the alveoli. There are many possible reasons for this. For example, the alveoli can collapse or become blocked, or they can be compressed from the outside. In any case, the area in question is no longer available for gas exchange. Atelectasis is therefore a serious condition.
Forms of atelectasis
Doctors basically differentiate between two forms of atelectasis:
- Primary or congenital atelectasis: This form only affects newborns or premature babies and is also known as fetal atelectasis.
- Secondary or acquired atelectasis: occurs as a result of another condition.
Atelectasis: symptoms
Atelectasis restricts lung function. The symptoms that result from this depend, among other things, on the size of the affected lung segment and whether the atelectasis developed suddenly or gradually. The cause of the collapse of the lungs also shapes the symptoms.
Acquired atelectasis: symptoms
Atelectasis means that gas exchange can no longer take place in the affected section of the lung. As a result, the oxygen level in the blood drops. The organism tries to compensate for this condition through accelerated breathing and an increased heart rate. As a sign of the low oxygen level in the blood, some affected people develop a bluish skin discoloration - doctors call this cyanosis.
If the atelectasis occurs suddenly, for example because the airways are blocked, those affected complain of severe shortness of breath (dyspnoea) and, in some cases, sharp pain in the chest. If large areas of the lungs collapse, circulatory shock can also occur. The blood pressure suddenly drops sharply and the heart beats very quickly (tachycardia).
An atelectasis that develops slowly and only affects smaller areas of the lungs, on the other hand, causes only mild symptoms. Some of those affected notice that they are short of breath and quickly become out of breath, especially when exerting themselves. It also happens that minor atelectasis goes unnoticed.
Congenital atelectasis: symptoms
Symptoms of congenital atelectasis, as it occurs in premature babies, often appear immediately after birth or within the first few hours of life. The skin of the affected premature babies turns bluish. You breathe quickly. The areas between the ribs and above the breastbone are drawn in as you inhale, and the wings of the nose move more intensely. Affected children often moan as they exhale as an expression of their shortness of breath.
Atelectasis: causes and risk factors
Congenital and acquired atelectasis can have many different causes.
Congenital atelectasis: causes
The following causes are possible for congenital atelectasis:
- Lung immaturity: Normally, in the last few weeks before birth, the lungs mature completely and produce sufficient amounts of the substance surfactant. This is located in the alveoli and reduces the surface tension of liquids - alveoli are covered by a thin film of liquid. Premature babies, on the other hand, are often deficient in surfactant - the alveoli collapse, so the lungs cannot develop properly after birth ("respiratory distress syndrome in premature babies").
- Obstructed airways: If the newborn inhales mucus or amniotic fluid, the lungs cannot properly fill with air. Atelectasis can also result from malformations that hinder the airflow in the airways.
- Disturbance of the respiratory center: If the respiratory center in the brain is damaged (for example due to a cerebral hemorrhage), the reflex to take a breath may be absent after the birth.
- Diaphragmatic hernia: The diaphragm (the muscle plate that separates the chest from the abdomen) is malformed here - it has a gap. This allows abdominal organs to slide into the rib cage and compress the lungs so that they have no room to inflate after birth.
Acquired atelectasis: causes
Causes of acquired atelectasis are:
- Obstruction atelectasis: Here the airways are blocked, for example by a tumor, thick mucus or a foreign body.
- Compression atelectasis: The lungs are compressed from the outside, for example by an effusion of fluid in the chest or a very enlarged lymph node.
- Relaxation atelectasis: Its cause is a so-called pneumothorax (= air entry between the lungs and chest wall, causing the lungs to partially collapse). For example, a pneumothorax can result from an injury to the chest or various lung diseases.
Atelectasis: examinations and diagnosis
Usually typical symptoms point to atelectasis - in many cases the underlying disease also suggests that there is a dysfunction of the lungs.
Congenital atelectasis
If a child is born prematurely (born before the 37th week of pregnancy), doctors already expect breathing problems as a result of a lack of lung maturity. Immediately after the birth, the midwife and pediatrician pay particular attention to the baby's breathing, skin color, heart rate, reflexes and muscle tension. Abnormalities such as bluish skin color or increased or weak breathing indicate that there are problems.
An X-ray examination confirms the diagnosis and also shows the degree of immature lungs.
The diagnosis of congenital atelectasis is usually made by a pediatrician who specializes in treating premature babies (neonatologist).
Acquired atelectasis
In the case of acquired atelectasis, the diagnosis of the underlying disease is usually in the foreground. To do this, the doctor first conducts a detailed discussion with the patient and asks him about his symptoms and any underlying diseases (anamnesis).
This is followed by a physical examination: the doctor listens to the person's lungs with a stethoscope. In the case of atelectasis, the normal breathing sounds are weakened.
In addition, the doctor taps the chest with his fingers - the tapping sound is different in the area of atelectasis.
An X-ray examination of the chest (chest X-ray) provides definitive evidence of whether there is atelectasis. Depending on the possible cause (e.g. lung tumor, effusions of blood or fluid in the chest, foreign bodies in the respiratory tract), further examinations are concluded. These include, for example, blood tests, ultrasound examinations, computed tomography (CT) and / or magnetic resonance imaging (magnetic resonance imaging, MRI).
Atelectasis: treatment
Therapy for atelectasis is primarily based on its cause. The primary goal is to restore lung function as soon as possible and to supply the body with sufficient oxygen.
If, for example, a foreign body or a plug of mucus in the airways is the reason for the collapsed lung area, this must be removed or suctioned accordingly.
If bacterial pneumonia or a lung abscess (encapsulated collection of pus in the lungs) is the reason for the lack of ventilation in the lungs or in part of the lungs, the patient is treated with antibiotics.
If a lung tumor is responsible for atelectasis, it is usually surgically removed.
In the case of a pneumothorax, the air that has entered between the lungs and the chest wall is often sucked out through a thin tube (pleural drainage). In mild cases, however, treatment is not always necessary - one waits for spontaneous healing (under clinical observation of the patient).
Congenital atelectasis is mostly due to insufficient lung maturity or a lack of surfactant. To compensate for this deficiency, premature babies receive this substance as a drug. If the breathing problems are very pronounced, the baby is artificially ventilated through a thin tube in the windpipe (tube).
Atelectasis: disease course and prognosis
Atelectasis is not an independent disease, but a side effect that can have many different causes. A general statement about the course or the prognosis is therefore not possible. Rather, the underlying disease decides how the disease will progress. If this can be treated well, the function of the lungs can usually be restored.
With congenital atelectasis in premature babies, the prognosis depends on numerous factors. Basically, the earlier a child is born, the more immature the lungs. However, it is not possible to predict which problems will arise in premature babies. Even extremely premature babies with atelectasis can develop well, while a later date of birth is no guarantee of a complication-free course.
Atelectasis: prevention
Acquired atelectasis cannot be prevented by any specific measure.
Congenital forms, such as respiratory distress syndrome in premature babies, can, however, be counteracted to a certain extent: Pregnant women who are at risk of premature birth are given a drug that promotes lung maturation in the unborn child. This is a so-called corticosteroid (usually betamethasone). In addition, the women are given a contraceptive drug to delay the birth of the child as long as possible - this gives the lungs more time to mature and thus lowers the risk of congenital atelectasis.
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