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PubMed1983

[Round atelectasis].

The authors report 4 cases of round atelectasis seen over a period of 3 years. They review the very limited literature on this subject. In the light of their experience and according to the work of Hanke, they believe this to be a fairly common disease. This condition was first described during collapsotherapy, but now, it is essentially seen following pleurisy. For Hanke, round atelectasis may occur in almost one quarter of cases of pleural effusion. The authors also believe that this condition is common and that it is usually confused with or grouped together with "pleural sequelae". However, their original mechanism of formation, the reversible parenchymal involvement, and not pleural, and their radiological appearance clearly distinguish them. Round atelectasis is an interesting topic of discussion in terms of diagnosis, in the broad framework of round intrathoracic opacities (especially when the initial pleural episode has not been recognized) and also in terms of treatment, which consists of decortication when they are large.

Adult↗
PubMed1982

The image of the round atelectasis in the transverse plane: a CT study.

Computerized tomography (CT) was performed on 6 patients presenting a round atelectasis of the lung. It showed that the image of the round atelectasis in the transverse plane is specific and has analogous characteristics to the image produced in conventional tomography. CT scanning showed that more lung segments were involved in the collapse than was suggested by conventional tomography. The restrictive nature of the round atelectasis was evident on the CT scan.

Aged↗
PubMed1995

Rounded atelectasis associated with silicosis.

Two cases of autopsy-proven, silicosis-associated rounded atelectasis (SARA) are reported. Clinicopathologically, SARA shows a combination of rounded atelectasis and the typical features of silicosis. Pathologically, SARA is characterised by the presence of numerous silicotic nodules deposited throughout the atelectatic lung tissue, which otherwise shows the ordinary features of rounded atelectasis. SARA may contribute to the development of massive fibrosis in silicotic lungs.

Aged↗
PubMed1994

[Rounded atelectasis: another pulmonary pseudotumor].

Rounded atelectasis or Blesovsky's syndrome (also called pleuroma, folded lung or shrinking pleuritis with atelectasis) is the association of plaque-like pleural fibrosis with a folding visceral pleura and nodular atelectasis of the underlying lung. It can mimic a peripheral lung tumor or a mesothelioma. Radiography and computed tomography (CT) show a characteristic opacity with a comet-tail sign. The pathogenesis in some of the cases is considered to be secondary to pleural effusions and in others to a contraction of a focus of pleural fibrosis, not associated with effusion. In many cases, there was a history of asbestos exposure. We report the case of a 44-year-old, man who had smoked and worked with materials containing asbestos. He referred thoracic pain of 6 months duration and dyspnea. An X-ray of the chest (Fig. 1, 2) and a CT scan (Fig. 3) revealed a round peripheral mass in the left lower lobe. A fine needle aspiration biopsy of the lung was performed revealing clusters of large atypical cells with abundant cytoplasm. A thoracotomy was decided upon and no frozen section was requested. Gross examination of the resected lobe (Fig. 4) demonstrated a 2.5 cm white, irregular, firm and retracting pleural plaque. On sectioning, a peculiar folding of the visceral pleura delimited by anthracotic pigmentation was noted below the fibrotic plaque. The folding extended perpendicularly deep into the parenchyma. It was possible to separate the folding and liberate the underlying parenchyma, which was firm, fibrotic and atelectatic. No tumor was found anywhere within the lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗
PubMed1995

[Mycoplasma pneumonia found by the occurrence of atelectasis during the induction of anesthesia in a child with tetralogy of Fallot].

A 3-yr-old girl was scheduled to undergo surgical repair of tetralogy of Fallot. She had no sign or data indicating an infectious disease, other than a slight dry cough for a few days prior to the proposed operation. During the induction of anesthesia with nitrous oxide, oxygen and sevoflurane, transient moist rale was noticed with a precordial stethoscope. Her trachea was intubated without any difficulty after the administration of pancuronium, followed by a chest auscultation, which revealed vesicular sound bilaterally but no rale. However, a chest X-ray taken after the right subclavian vein catheterization showed a massive hypoaeration in the upper left pulmonary region. The presence of the right-to-left intracardiac shunt made it impossible to detect the occurrence of atelectasis by a decrease in SpO2. Fiberoptic bronchoscopy showed no obstruction of the bronchus and no hypersecretion initially, but physical therapy and humidification made it possible to aspirate intratracheal sputum. Because there seemed to be an imbalance between the relatively uneventful induction of anesthesia and the relative resistance of atelectasis to authentic therapies, the operation was postponed, and the antibody to mycoplasma pneumoniae was titrated. The titer in the serum was 1:80, and increased to 1:560 6 days later. Chest X-rays revealed normal lung condition 3 days later, and she was given erythromycin, 800 mg.day-1 for 2 weeks. We conclude that we should be alert to possible asymptomatic mycoplasma infection, which potentially makes patients susceptible to atelectasis during the perioperative period.

Anesthesia, Inhalation↗
PubMed1994

[A case of endobronchial tuberculosis complicated with atelectasis of right upper lobe].

A case of endobronchial tuberculosis complicated with atelectasis of upper lobe of the right lung is reported. A 79-years old female was admitted to our hospital for rehabilitation of her Parkinsonisms. On admission, her chest X-ray photo showed atelectasis of right upper lobe. A nodule of a broad-bean size was observed at the orifice of the right upper bronchus by a bronchofiberscopic examination and it was considered as the cause of the atelectasis. Histological examination of a specimen obtained by transbronchial biopsy of this nodule showed epithelioid granuloma. Mycobacterium tuberculosis was isolated from a bronchial washing after 4-weeks cultivation. Anti-tuberculous treatment with INH, RFP and EB was started on January 1992 and, consequently, her chest X-ray findings showed remarkable improvement. Bronchofiberscopic examination in January 1993 showed a marked reduction in the size of the nodule, and the atelectactic shadow had disappeared and just a residual scar was observed on her chest X-ray photo in June 1993.

Aged↗
PubMed1996

[A case of enlarging rounded atelectasis difficult to distinguish from a pulmonary neoplasm].

A 55-year-old man with occupational exposure to asbestos presented with a chest roentgenographic abnormality that was found during a physical check-up. Computed tomography disclosed pleural thickening and a pulmonary mass in the left lower lobe. A fine-needle biopsy was done, but the presence of a malignant lesion was not confirmed. The patient was asymptomatic. He was observed closely, and 10 months later computed tomography showed that the mass had enlarged. A fine-needle biopsy was done again, but no evidence of malignancy was found. We suspected that it was rounded atelectasis, but could not rule out a neoplasm. An exploratory thoracotomy was done, and the histopathological findings showed that the mass was lung tissue with alveolar wall fibrosis that had resulted in thickening of the wall. The mass was diagnosed as rounded atelectasis. Rounded atelectasis requires no special treatment, but if the mass increases in size as in the case of this patient, an exploratory thoracotomy is required.

Diagnosis, Differential↗
PubMed2005

Maxillary sinus atelectasis in a wild born gibbon (Hylobates moloch).

In a mixed sex sample of ten adult gibbon (Hylobates moloch) skulls, one cranium of a male with maxillary sinus atelectasis of the left side was identified. While external inspection revealed a slight drop of the left orbital floor, serial coronal computer tomography (CT) scans show characteristic changes of the left maxillary sinus and its surrounding structures. In addition to the sunken orbital floor, radiological features of the specimen include an inward bowing of the medial sinus wall, sinus opacification, and a reduction in maxillary sinus size to a slit-like cavity, which suggest a diagnosis of silent sinus syndrome. This report is the first, to our knowledge, of maxillary sinus atelectasis in a non-human primate. This finding is valuable for the understanding of the pathogenesis and etiology of maxillary sinus atelectasis. At the same time, however, paleoanthropologists and primatologists may refer to this information when dealing with the interpretation of maxillary sinus pneumatization of partially broken archaeological and fossil skulls.

Animals↗
PubMed1980

Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment of the so-called middle lobe syndrome.

Isolated atelectasis of the middle lobe has been known for many years as the "middle lobe syndrome". Several clinical studies have shown that it may bae caused by malignant tumours. A 10-year study of 135 patients with isolated middle lobe atelectasis is presented. Fifty-eight patients (43%) had malignant tumours. Of 38 who had a thoracotomy, lung resection was possible in 25. In 20 patients regional or systemic dissemination of the tumour had been diagnosed before operation. Seventy-seven patients had benign diseases, of which 74 were non-specific infections. Bronchography was performed in 46 of these cases, and all had abnormal findings in the middle lobe, eight revealing definite bronchiectasis. In three cases tuberculosis was found. In 16 cases the benign diagnosis was established at thoracotomy. Only three patients out of 58 with malignant tumours lived more than five years. Atelectasis of the middle lobe is always a sign of potential malignancy especially in patients with a previously normal chest radiograph.

Adolescent↗
PubMedDate not supplied

Atelectasis and secretory otitis media.

That condition where the tympanic membrane is displaced toward the promontory is termed atelectasis. Thirty-seven patients (61 ears) showing various degrees of atelectasis graded from stage 1 to stage 4 were studied. Atelectatic drums are an inflammatory phenomenon occurring in underventilated ears. This conclusion is reached by considering the reversibility of the atelectasis upon ventilation; while the inflammatory factor can be deduced from the history and histopathology of the atelectatic drum, as well as the histology of the necrosed incus, the latter occurs in over a third of our cases. Also pneumatization of the mastoid is almost never present. Twelve (21%) of the ears treated did indeed develop a perforation at one time or another (two had cholesteatomas). Chronic granulating external otitis with specific features occurred in 15% of cases. The characteristics of these ears and their case histories lead us to view atelectatic ears as part of the otitis media syndrome, where their place is somehow transitional between secretory otitis media on the one hand and chronic otitis media on the other.

Adult↗
PubMed1983

Re-expansion of refractory atelectasis using a bronchofiberscope with a balloon cuff.

For the re-expansion of refractory atelectasis, it is necessary to remove sputum in the airway and to deliver the intrabronchial positive pressure to the atelectatic lobe in order to overcome the critical opening pressure of the alveoli. Selective intrabronchial air insufflation is effective for this purpose, because with this procedure, endobronchial pressure in the atelectatic region can be selectively increased without elevation of the pleural surface pressure in the surrounding region of the lung. The inflator devised consisted of a flexible bronchofiberscope with a small balloon cuff at the distal end; through the fiberscope air was insufflated into the atelectatic lung. Using our procedure, we successfully performed intrabronchial insufflation in 14 of 15 patients with atelectasis, who had failed to respond to conventional therapy. In six patients, atelectasis recurred, and the same treatment was successfully performed again.

Acute Disease↗
PubMedDate not supplied

A rare complication of functional endoscopic sinus surgery: maxillary atelectasis-induced spontaneous enophthalmos.

BACKGROUND: The first case report of spontaneous enophthalmos due to maxillary atelectasis as a late complication of FESS is presented. METHODS: Chart review of a 24-year-old male who developed a left progressive enophthalmos within three months post bilateral functional endoscopic sinus surgery. RESULTS: The preoperative computed tomography showed a normal left maxillary sinus. The postoperative computed tomography revealed a left maxillary atelectasis with a descending orbital floor. The subject received revised endoscopic sinus surgery and his enophthalmos was stable without further progression after the operation. CONCLUSIONS: This may have been caused by an ostium occlusion with retention of secretions inducing sinus inflammation, osteolytic activity, and osseous remodeling of the sinus walls. A negative pressure may develop. When the pressure gradient exceeds the sinus wall tension, maxillary atelectasis and enophthalmos occur. Prevention of this complication of FESS should include making a patent naso-antral window, minimizing mucosal trauma, and careful postoperative sinoscopic treatment. A "functional" sinus is the goal.

Adult↗
PubMed1999

Migrating atelectasis in Werdnig-Hoffmann disease: pulmonary manifestations in two cases of spinal muscular atrophy type 1.

Spinal muscular atrophy (SMA) or Werdnig-Hoffmann disease is the second most common neuromuscular disease, with 25% of cases presenting in infancy. Deletions in the survival motor neuron gene are believed responsible for autosomal-recessive SMA. SMA affects about 1 in 10,000 births. Symptomatic newborns have severe hypotonia, may have respiratory distress, may be unable to feed, and rapidly progress to death early in infancy. This paper describes another early pulmonary manifestation of SMA, i.e., migrating or rotating atelectasis, in 2 patients with infantile SMA. Migrating or rotating atelectasis may suggest the diagnosis of SMA.

Humans↗
PubMed1988

Selective bronchial intubation for acute post-operative atelectasis in neonates and infants.

Selective bronchial intubation and lavage under fluoroscopic control was performed in 10 surgical neonates and infants to clear lobar atelectasis, after standard physiotherapeutic techniques had failed. Full re-expansion of the lung was obtained in all cases. The indications and techniques of selective bronchial intubation and lavage are described. This manoeuvre can be recommended in early post-operative atelectasis in neonates and infants if non-invasive measures have failed.

Bronchi↗
PubMed1981

Pulmonary atelectasis after anaesthesia: pathophysiology and management.

The pathophysiological basis of pulmonary atelectasis is reviewed and risk factors that enhance lung collapse are discussed. Management strategies to reduce or eliminate risk factors and to prevent collapse are discussed and the rational bases of these strategies are identified. Instability of lung alveoli is a consequence of surface tension and regional differences in alveolar size. The inherent tendency of alveoli to collapse is enhanced by the following risk factors; low lung volume, high closing volume, oxygen therapy, a rapid shallow ventilatory pattern, chronic lung disease, smoking, obesity, postoperative pain following abdominal or thoracic surgery, narcotic induced ventilatory depression, and neurological, neuromuscular, muscular and musculoskeletal diseases associated with mechanical impairment of respiratory function. The primary goal of perioperative respiratory management is prevention of atelectasis. Appropriate management strategies include physiotherapy and delay of elective surgery if substantial improvement in respiratory status can be achieved by specific treatments such as antibiotics, bronchodilators, steroids, and reduction of tobacco use and caloric intake. In selected cases, elective postoperative controlled ventilation may be indicated.

Analgesia↗
PubMed2000

[Ventilation in prone position in a 5-year-old child after multiple trauma. Effective treatment of persistent atelectasis].

We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgesic sedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artificial ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase in arterial oxygenation, which persisted in the following period. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically after supine repositioning. After cessation of analgesic sedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.

Abdominal Injuries↗
PubMed1983

Lobar blood flow, blood volume and water content in atelectasis.

In nine intact supine anesthetized dogs we measured pulmonary blood flow distribution, lobar hemoglobin content, and lobar wet wt/dry wt during left lower lobe collapse. The animals breathed a mixture of 88% O2/12% N2 and atelectasis was induced by occluding the left lower lobe bronchus. Lobar volume was assessed by measuring lobar N2 concentrations. Using the radioactive microsphere technique, perfusion distribution was measured at lobar volumes of 50% FRC and 18-25% FRC. Hemoglobin content and wet wt/dry wt were measured at the latter volume. At 50% FRC lobar blood flow was unchanged though lobar pressure was negative. At the lower volume lobar blood flow averaged 72% of that at FRC, and lobar hemoglobin content was similar to that of the right lower lobe, indicating that lobar blood volume was unchanged. Wet wt/dry wt was significantly less in collapsed left lower lobes than in control right lower lobes, perhaps indicating that pressure in fluid-exchanging vessels was less than interstitial pressure during atelectasis.

Animals↗
PubMedDate not supplied

Profound atelectasis following alkaline corrosive airway injury.

We report a case of life-threatening acute atelectasis following intubation for alkaline corrosive injury to the upper airway. The risk factors for and diagnosis of acute atelectasis as well as current methods of treatment are reviewed. It is important for emergency physicians to be familiar with this potentially fatal respiratory emergency during care for acutely ill and injured patients.

Bronchi↗