Introduction
Notably, a thick mucous plug in a bronchial tube can make the air behind the plug absorb in the alveoli. As a result the lung tissue collapses. Whenever only part of the lung collapses, the name for this is atelectasis. Likewise, when one of the lungs collapses, physicians call this a pneumothorax. This can happen in COPD patients when one of the diseased alveoli ruptures. As soon as this happens, there is only a finite time (1 to 3 days) to reexpand the lung, otherwise infections sets in and the pneumothorax stays permanently.
Symptoms
All in all, with the right lower lung lobe in partial or complete collapse (=atelectasis) might feel to the patient like an acute abdominal pain in the right upper abdomen. In essence, this is because the diaphragm, which divides the chest cavity from the abdominal cavity, experiences irritation and sends referred pain to the upper abdomen. For the most part, however, the majority of symptoms will be in the chest cavity with shortness of breath, painful breathing (=dyspnea) and bluish skin discoloration, called cyanosis. Consequently, the patient presents with a fever, a fast heart beat and a drop in blood pressure.
Findings in patient with atelectasis
In the meantime, the physician notices on examination a reduction in chest wall movements at the side where the symptoms are. Moreover, on auscultation (=exam with the stethoscope) the physician cannot hear the breath sounds over the collapsed lung tissue. Equally important, with percussion there is dullness over the area. Finally, chest X-rays will confirm the diagnosis of atelectasis. An atelectasis can develop following surgery, particularly after surgery in the upper abdomen or of the stomach. In the same way, unconscious patients develop a collapsed lung easily. Conditions where tenacious bronchial secretions develop (such as asthma or chronic bronchitis) can lead to a collapsed lung. If a foreign body is aspirated and obstructs the airways, this too poses a higher risk to develop this condition.
Collapsed Lung
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, a lung specialist (=respirologist) needs to do an urgent bronchoscopy. 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 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 the physician administers a broad spectrum antibiotic.
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.
