Pulmonary Atelectasis Clinical Presentation

Updated: May 06, 2018
  • Author: Nazir A Lone, MD, MBBS, MPH, FACP, FCCP; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Presentation

History

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  • Most symptoms of pulmonary atelectasis are nonspecific and related to the underlying disorder. The clinical presentation depends on the underlying cause and the degree of volume loss of lung.

  • Atelectasis alone only causes tachypnea as the child attempts to compensate for decreased tidal volume by increasing the frequency of respiration.

  • If the atelectasis is large enough, the child may grunt in an attempt to create auto–positive end-expiratory pressure (PEEP), both to improve oxygenation and to attempt to open the atelectatic areas.

  • If a child has underlying cardiopulmonary or neuromuscular disease and is on a monitor, sudden decreases in oxygen desaturation may be a sign of atelectasis. Atelectasis is one of the most common causes of sudden decreases in oxygen saturation in children.

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Physical

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  • Most findings upon physical examination are related to the underlying disorder. In one study comparing physical examination to chest radiography in children, [7] out of 35 children with radiographically proven atelectasis, the atelectasis was detected by physical examination in only 8.

  • Breath sounds may be decreased in the atelectatic portion of the lung, although the segment involved may be so small that the changes cannot be perceived. Also, the atelectatic portion may be in a segment inaccessible to the stethoscope.

  • If the atelectatic portion and chest wall are large enough, dullness to percussion may be detected.

  • The atelectasis may also occur in the right middle lobe or lingula in an adolescent girl. Because both are anteriorly located, the physician must listen to the anterior chest of the patient to hear these lobes. If the physician feels awkward about examining this area and fails to do so, the lobes are not correctly evaluated, and any corresponding abnormalities are not heard.

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Causes

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  • Obstruction of an airway or diminished distention of alveoli may cause atelectasis

  • Depending on the causative mechanism, atelectasis may be acute or chronic

  • The most common causes involving airway obstruction include the following:

    • Airway obstruction due to a mucous plug or other airway secretions, such as with bronchiolitis

    • Bronchospasm airway secretions and airway inflammation in patients with asthma

    • Abnormal airway secretions in cystic fibrosis

    • Abnormal airway clearance, such as with ciliary dyskinesia syndrome

    • Airway foreign body

    • Extrinsic compression on an airway (eg, compression due to an enlarged or aberrant vessel)

    • Enlarged lymph nodes that compress the airway

    • Masses in the chest that compress the airway or alveoli

    • Cardiomegaly or enlarged pulmonary vessels that compress adjacent airways

  • Causes of diminished alveolar distention include the following:

    • Small or dysmorphic chest wall

    • Severe scoliosis

    • Neuromuscular diseases

    • Anesthesia or sedation

    • Pain from upper abdominal surgery

    • Abdominal distention

    • Chest wall or upper abdominal pain

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