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Round atelectasis is a rare lung pseudotumor that is most commonly associated with asbestos-related pleural disease but can result from a variety of chronic pleural diseases. We describe a patient who developed round atelectasis over a period of only several months following an acute pleuropulmonary illness caused by Legionnella pneumophila.
STUDY OBJECTIVES: To investigate the effects of deep-breathing exercises on pulmonary function, atelectasis, and arterial blood gas levels after coronary artery bypass graft (CABG) surgery. DESIGN, SETTING, AND PATIENTS: In a prospective, randomized trial, patients performing deep-breathing exercises (n = 48) were compared to a control group (n = 42) who performed no breathing exercises postoperatively. Patient management was similar in the groups in terms of assessment, positioning, and mobility. INTERVENTIONS: The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days. The exercises consisted of 30 slow, deep breaths performed with a positive expiratory pressure blow-bottle device (+ 10 cm H(2)O). MEASUREMENTS AND RESULTS: Spirometric measurements, spiral CT (three transverse levels), arterial blood gas analysis, and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day. Atelectasis was only half the size in the deep-breathing group compared to the control group, amounting to 2.6 +/- 2.2% vs 4.7 +/- 5.7% (p = 0.045) at the basal level and 0.1 +/- 0.2% vs 0.3 +/- 0.5% (mean +/- SD) [p = 0.01] at the apical level. Compared to the control subjects, the patients in the deep-breathing group had a significantly smaller reduction in FVC (to 71 +/- 12%, vs 64 +/- 13% of the preoperative values; p = 0.01) and FEV(1) (to 71 +/- 11%, vs 65 +/- 13% of the preoperative values; p = 0.01). Arterial oxygen tension, carbon dioxide tension, fever, or length of ICU or hospital stay did not differ between the groups. In the deep-breathing group, 72% of the patients experienced a subjective benefit from the exercises. CONCLUSIONS: Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises.
Rounded atelectasis is an interesting roentgenographic entity that must be distinguished from intrathoracic neoplasm. Chronic pleural disease, particularly that due to asbestos exposure, is a frequently cited cause, and is considered to be a sine qua non by some. We report a case of rounded atelectasis with an acute parapneumonic exudative effusion that resolved spontaneously with roentgenographically normal pleura.
In a prospective randomized trial, we examined the value of routine postlobectomy fiberoptic bronchoscopy (FOB) in preventing postoperative atelectasis. Twenty patients who underwent lobectomy were randomly assigned to either chest physical therapy alone (group 1) or immediate bronchoscopy (group 2). Both group 1 and group 2 were placed on a standard physical therapy regimen consisting of aerosol bronchodilator therapy, chest percussion, and incentive spirometry. It was concluded that routine postlobectomy bronchoscopy offers no advantage over the usual physical therapy measures in preventing the development of postoperative atelectasis.
A patient with a history of asbestos exposure developed rounded atelectasis. The mass was associated with local bronchial obstruction, obstructive pneumonia and arterial thrombosis. Autopsy demonstrated marked pleural thickening and radiographically inapparent asbestosis. This is the first reported case in which seemingly benign rounded atelectasis not only increased morbidity, but also contributed to mortality through airway obstruction and local arterial thrombosis.
Rounded atelectasis (RA) is a benign and unusual form of subpleural lung collapse that has been described mostly in asbestos-exposed workers. This form of atelectasis manifests as a lung nodule and can be confused with bronchogenic carcinoma upon conventional radiologic examination. The objective of the present study was to evaluate the variation in contrast uptake in computed tomography for the identification of asbestos-related RA in Brazil. Between January 1998 and December 2000, high-resolution computed tomography (HRCT) was performed in 1658 asbestos-exposed workers. The diagnosis was made in nine patients based on a history of prior asbestos exposure, the presence of characteristic (HRCT) findings and lesions unchanged in size over 2 years or more. In three of them the diagnosis was confirmed during surgery. The dynamic contrast enhancement study was modified to evaluate nodules and pulmonary masses. All nine patients with RA received iodide contrast according to weight. The average enhancement after iodide contrast was infused, reported as Hounsfield units (HU), increased from 62.5+/-9.7 to 125.4+/-20.7 (P < 0.05), with a mean enhancement of 62.5+/-19.7 (range 40 to 89) and with a uniform dense opacification. In conclusion, in this study all patients with RA showed contrast enhancement with uniform dense opacification. The main clinical implication of this finding is that this procedure does not permit differentiation between RA and malignant pulmonary neoplasm.
A 73-year-old male was admitted with a large rounded atelectasis with pleural effusion. The involved lung was refilled with air as soon as surgical decortication of the thickened visceral pleura covering it was performed. Surgical treatment is believed to be necessary when a large rounded atelectasis with pleural effusion persists for a long time, or when malignancy is not completely excluded.
A 54-year-old nonsmoker female developed atelectasis of the anterior basal segment of the right lower lobe. A non-pulsating endobronchial tumor was observed bronchoscopically obstructing the right basal bronchus. The tumor was confirmed on arteriography to be a saccular aneurysm of the right bronchial artery. The aneurysm was treated with bronchial artery embolization. Bronchial artery aneurysm, without a predisposing disease, is quite rare, but should be considered as an etiological factor of atelectasis.
Rounded atelectasis is an unusual form of lung collapse that develops as a consequence of pleural diseases. Among a variety of conditions, asbestos inhalation has been attributed in most cases, but many other causes have also been implicated. Here, we describe the first case of rounded atelectasis and pneumothorax associated with pulmonary lymphagioleiomyomatosis.
Rounded atelectasis is an uncommon but increasingly recognized benign form of peripheral lung collapse. The three patients described here had pleural-based lung masses considered initially to represent carcinoma. On computed tomography, a characteristic appearance of eight major and five minor signs of rounded atelectasis of the lung were found. In conjunction with other radiologic evaluations, these allowed the patients to be confidently managed without exploratory thoracotomy.
Rounded atelectasis (folded lung syndrome) is a form of pulmonary collapse associated with pleural thickening that can mimic a neoplasm on plain chest radiographs. The abnormality was diagnosed radiologically in nine patients in whom follow-up varied from 1 to 6 years. Four patients had bilateral lesions, making a total of 13 examples. The CT findings were analyzed and compared with previously published criteria for the diagnosis of this disorder. In all cases, CT showed a rounded mass, 3.5-7.0 cm in diameter, abutting a thickened pleural surface in the lung periphery. The margin closest to the hilum was blurred by the entering vessels in 92% of the cases. Our experience suggests that the CT findings of rounded atelectasis are characteristic of the abnormality.
OBJECTIVE: This study describes the atypical presentation of atelectasis as a pseudomass in patients with severe bullous emphysema. MATERIALS AND METHODS: The radiologic studies and clinical records of 11 patients with severe bullous emphysema and mass-like opacities representing atelectatic lung were reviewed. The diagnosis was proven by surgery in nine patients and by follow-up imaging in two patients. RESULTS: Pseudomasses were found primarily in the upper lobes and the right middle lobe (n = 10). Common features included an oblong, lenticular, or triangular shape (n = 8); a sharp interface with aerated lung (n = 9); hyperexpansion of the hemithorax containing the pseudomass (n = 8); a central location abutting the mediastinum (n = 8); and adjacent emphysema (n = 11). CT revealed subsegmental atelectasis in other lobes adjacent to the bullous lung in six patients. In three patients, the pseudomasses were associated with persistent distention of large bullae following spontaneous pneumothoraces. Reexpansion of pseudomasses occurred in seven of the eight patients who underwent resection of bullous lung. CONCLUSION: These pseudomasses most likely result from compression of the lung by adjacent large bullae. The diagnosis should be suspected when central, sharply marginated, mass-like opacities that are oblong, lenticular, or triangular are bordered by severe bullous emphysema.
Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is a clinicopathologic entity established by Frizzera in 1974. Reported cases of AILD with pleuropulmonary involvement have been increasing recently. At Nogata Central Hospital, an 82-year-old male inpatient with brain infarctions and chronic bronchitis showed a rapid growth of systemic lymphadenopathy and various other symptoms. We diagnosed the case as AILD by histopathologic examination of a lymph node. Chest radiography and computed tomography demonstrated a loss of volume of the right lung caused by intrathoracic lymphadenopathy and a pleural effusion. Although cases of AILD with pleuropulmonary involvement have been increasing, no cases with almost total atelectasis of a lung have been reported as yet. AILD should be taken into account as a disease which may cause atelectasis of a lung.
We report a case of a 68-year-old patient with a history of chronic asbestos exposure and a lung tumour, highly suspicious for bronchial carcinoma. The patient underwent left lower lobectomy and histology showed the rare diagnosis of rounded atelectasis. Rounded atelectasis is an important differential diagnosis to bronchial carcinoma.
Purpose of this paper is to evaluate the risk of ateletasis in patients that underwent surgery of the abdomen (cesarean section), since the reflex of cough in these patients is notably altered for the limitation of the diaphragmatic excursions, due to analgesic contracture. The inhibition of cough's reflex causes retention of secretions with consequent bronchial obstruction and atelectasis. Personal experience in 6 cases of atelectasis following cesarean section is reported.
BACKGROUND: Severe pulmonary oxygenation impairment occurred in some patients with pleurotomy during the harvest of the internal mammary artery graft followed by coronary artery bypass grafting (CABG). Peripheral pulmonary atelectasis in the postoperative chest X-ray was detected in these patients. We studied the efficacy of intraoperative positive end-expiratory airway pressure (PEEP) therapy for the prevention of postoperative pulmonary oxygenation impairment. METHODS: The pleural cavity was intraoperatively opened in 40 patients with solitary CABG procedure performed during 5 years since January 1992. These patients were divided into two groups. Intraoperative PEEP therapy, which is initiated just after pleurotomy, was not used in 32 patients before May, 1996 (control group) and used for recent 8 patients with pleurotomy (PEEP group). The mean age of patients was 60 years old in the control group and 68 in the PEEP group. RESULTS: Respiratory insufficiency (A-aDO2 >400 mmHg and RI >1.5) was detected in 6 patients in the control group. Three out of these 6 patients required long-term mechanical respiratory support over a week. No respiratory insufficiency occurred in patients of the PEEP group. Values of PaO2, A-aDO2, respiratory index and shunt ratio were significantly worse in the control group than in the PEEP group. CONCLUSIONS: In conclusion, PEEP therapy may prevent pulmonary atelectasis and oxygen impairment after CABG.
OBJECTIVE: To report about 6 new patients with round atelectasis of the lung, 1 of them professionally exposed to asbestos and another to silicates. RESULTS: The patients, 5 males and 1 female, presented with a peripheral, rounded pulmonary opacity, simulating a neoplasm. The examination of the surgical specimen revealed a pleuritis, with multiple pleural folding: the underlying lung parenchima was compressed, but otherwise unremarkable. CONCLUSIONS: Round atelectasis is relatively unusual for the pathologist. However, the correct diagnosis is potentially important, because the lesion can be the sign of a significant asbestos exposure.
A 5-month-old boy was diagnosed as having complete atelectasis of the right lung due to RS virus infection at the age of 1 month. Conventional respiratory physical therapy, inhalation therapy and mechanical ventilation through an endotracheal tube failed to re-expand the right lung, while the left lung gradually became overinflated. We therefore tried differential lung ventilation by using a combination of a laryngeal mask airway and an extra long endotracheal tube (ID, 3.5 mm; length, 280 mm; Portex Pediatric Tracheal Tube, Extra length; SIMS Portex Co., Ltd. UK). Following induction of anesthesia, a laryngeal mask airway #2 was inserted. Then, an extra long endotracheal tube was inserted through the laryngeal mask airway and was guided to the right main bronchus with the aid of a fiberscope. The right lung was selectively lavaged and inflated with high pressure while ventilation was maintained through the laryngeal mask airway. The SpO2 value was maintained at more than 95% throughout the procedure despite some leakage from the ventilation system. The case demonstrates that differential lung ventilation by use of a combination of a laryngeal mask airway and extra long endotracheal tube is useful for the treatment of a pediatric patient with severe atelectasis.