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Tracheal bronchus: a cause of prolonged atelectasis in intubated children.

Tracheal bronchus is a common anomaly that occurs in approximately 2% of people. Two children with multiple medical problems which led to endotracheal intubation are described. The hospital course for each child was complicated by persistent right upper lobe atelectasis. The presence of a tracheal bronchus was not recognized in either case initially; identification of this anatomic variant allowed appropriate changes in airway management. The potential for tracheal bronchus to cause, or be associated with, localized pulmonary problems is reviewed. The diagnosis of tracheal bronchus should be considered early in the course of intubated patients with right upper lobe complications.

Bronchi↗

Simulated paraspinal tumor or abscess by rounded atelectasis of the lower lobe.

Lower lobe atelectasis may simulate paraspinal tumor or abscess when margins of the completely collapsed lobe become rounded laterally and the inferior edge separates from the diaphragm. We believe this unusual appearance relates to (1) influence of the pulmonary ligament and (2) total collapse of the lobe to its minimum possible volume. Three cases of different etiologies are herein presented.

Adenoma↗

Bronchostenosis due to sarcoidosis: a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease.

Ninety-nine patients with clinically and histopathologically established sarcoidosis were studied during the period of January 1971 to October 1977 using the bronchoscope. In 32 patients, biopsy of the bronchial mucosa showed a microscopic picture typical of sarcoidosis. In eight (8 percent) of the 99 patients, severe stenosis of the bronchi was seen. We conclude that bronchial sarcoidosis with multiple segmental or lobar stenosis can closely imitate the clinical picture of chronic obstructive pulmonary disease. Bronchostenosis in sarcoidosis can cause atelectasis visible on the chest x-ray film and thus closely simulate a pulmonary neoplasm.

Adult↗

An unusual case of rounded atelectasis.

An unusual case of rounded atelectasis (RA) is described. This entity is likely to develop as a consequence of asbestos-induced pleural disease. The sine qua non of RA is a curvilinear tail extending from the inferior medial surface of a peripheral mass. Recognition of this "comet tail" prevents the necessity for surgery.

Asbestos↗

Rounded atelectasis associated with end-stage renal disease.

Three cases of end-stage renal disease are presented where plain radiographs of the chest suggested the diagnosis of rounded atelectasis. The clinical setting and follow-up radiographs in each case served to corroborate this diagnosis. The recognition of this benign condition in patients with end-stage renal disease may be important in obviating further invasive procedures in this subset of high risk patients.

Humans↗

Effect of cardiac output on gas exchange in one-lung atelectasis.

To evaluate the effect of administration of dobutamine on gas exchange in patients with one-lung atelectasis during pneumonectomy, ten patients with normal pulmonary function and localized carcinoma of the lung were studied during pulmonary resection. With each patient in the lateral decubitus position, hemodynamic profiles and oxygen transport data were recorded before and after administration of dobutamine at 5 micrograms/kg/min. Patients were ventilated with one-lung anesthesia and administration of 100 percent oxygen. With infusion of dobutamine, the heart rate, cardiac index, and LVSWI significantly increased. Mean arterial pressure increased while PAP fell. Systemic and pulmonary vascular resistance also declined. Arterial oxygenization and delivery improved, while oxygen uptake was unchanged. Pulmonary shunt fraction was significantly reduced. While the mechanism for shunt reduction in our patients is unclear, operative factors may include pulmonary vasodilation with dobutamine inhibition of HPV. The negative impact of reduced HPV may have been lessened by gravitational distribution of blood flow and dobutamine-mediated reduction in PAP in our patients.

Aged↗

Treatment of atelectasis with selective bronchial suctioning. Use of a curved-tipped catheter with a guide mark.

We applied our technique of selective bronchial suctioning (SBS) for the treatment of atelectasis (AT) of middle and lower lobes; nine patients with refractory ATs were successfully treated. We considered that SBS using a curve-tipped catheter with a guide mark (CTCGM) is the technique of choice for the treatment of refractory AT when conventional respiratory therapy is not effective and a bronchoscopist is not available.

Aged↗

Rescue use of DNase in critical lung atelectasis and mucus retention in premature neonates.

Excessive or thick pulmonary secretions are a common clinical challenge in the neonatal population. Mucus accumulation can cause many life-threatening complications, including plugging of the endotracheal tube and increasing the risk of pulmonary infections. We report 3 premature neonates who had critical pulmonary collapse secondary to mucous plugging. Different conventional methods to liquefy mucus and facilitate removal of secretions were exhausted to no avail. The rescue use of DNase was effective in reestablishing airway patency. Thus, this drug could be a valuable tool in treating atelectasis and mucus-plugging in mechanically ventilated, premature neonates.

Administration, Inhalation↗

Aspergillary bronchopneumonia: an unusual cause of atelectasis and asphyxia in a leukemic patient.

A 22-year-old man in his first relapse of T-acute lymphoblastic leukemia developed fever and a pulmonary infiltrate after 23 days of granulocytopenia. Although having been under amphotericin B for 10 days, productive purulent cough ensued, with right lobe atelectasis and acute ventilatory failure that resolved after the elimination of a thick gelatinous bronchial plug. Sputum cultures yielded Candida Albicans and Staphylococcus epidermidis, and microscopic examination of the sputum plug disclosed Aspergillus hyphae. The patient died 9 days after, of a disseminated Aspergillus infection, confirmed by necropsy.

Adult↗

Rounded atelectasis that disappeared after bronchoscopy.

We describe a 70-year-old man who presented with a round opacity that disappeared after bronchoscopy. Chest computed tomograms (CT) showed a round opacity in the left lower posterior lung field. Brushings and washings of the left B10 through bronchoscope yielded neither malignant cells nor acid fast bacilli. The patient was diagnosed as having a benign tumor and was not medicated. Chest CT 1.5 months after bronchoscopy showed that the round opacity had disappeared. Although this course was unusual, this radiopacity was quite typical of round atelectasis on the basis of CT appearance.

Aged↗

[Pulmonary atelectasis during anesthesia in a boy with upper respiratory tract infection].

A 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy. The main features of his case history were chronic otitis media, bronchial asthma and signs and symptoms of upper respiratory tract infection (persistent runny nose and cough, occasionally with fever). Immediately after tracheal intubation we observed that the right side of the chest failed to rise with inspiration; breathing sounds were absent on the right and hypoxemia developed. A chest film taken in the operating room revealed upper right lobe atelectasis. Surgery was postponed and tracheobronchial lavage was performed with fiberoptic bronchoscopy and aspiration of mucous plugs. Upper airway infections are a common problem in children and increase the risk of respiratory complications during anesthesia. Patients with upper respiratory tract symptoms present a dilemma, and consensus about how to deal with such situations is lacking. We review the literature, discuss the anesthetic implications of upper airway infections, and suggest a two-phase approach for cases such as we report: first myringotomy using general anesthesia and a face mask, and second, once the upper airway infection has resolved, adenoidectomy with general anesthesia and tracheal intubation.

Adenoidectomy↗

[Atelectasis of the right lower lobe in association with bronchiolitis obliterans organizing pneumonia].

A 58-year-old woman with underlying rheumatoid arthritis was admitted to the hospital because of a dry cough and the presence of an abnormal shadow in the right lower lung field. Consolidation and volume loss in the right lower lobe with air bronchogram were recognized on a chest tomogram. Bronchofiberscopic examination disclosed neither stenosis nor tumors in the large bronchi. Organizing pneumonia was recognized pathologically in transbronchial lung biopsy (TBLB) specimens. The volume of the right lower lobe decreased rapidly, and new infiltration shadows appeared in the right upper and middle lobes. Another bronchofiberscope examination revealed organizing pneumonia, and macrophage infiltrations were seen in the alveoli on histopathological examination of the TBLB specimens. The diagnosis of RA-associated BOOP was made on the basis of agreement of the expansion of the shadows on chest radiographs, the RA symptoms and the RA factor. The patient was treated with prednisolone, and the clinical course was satisfactory, with no recurrence. This case was of interest because BOOP inducing lobar cicatricial atelectasis is very rare.

Anti-Inflammatory Agents↗

Bronchial leiomyoma with atelectasis in the left lower lobe.

Bronchial leiomyoma with atelectasis in the left lower lobe occurred in a 44-year-old woman. The leiomyoma was diagnosed by bronchofiberscopy, and left lower sleeve lobectomy was performed. The histopathology of the tumor revealed a leiomyoma with no evidence of malignancy. An early accurate diagnosis is thought to be important for a more conservative treatment.

Adult↗

Computed tomography diagnosis of post-obstructive atelectasis by an endobronchial lipoma.

Endobronchial lipoma is a rare benign tumor in the bronchial tree. We report a case of endobronchial lipoma in a 73-year-old man with hemoptysis. Chest radiograph revealed atelectasis of the right upper lung. Bronchoscopy revealed a well-defined endobronchial lesion in the right upper lobe bronchus with near total occlusion, but a biopsy was not performed. An endobronchial tumor was identified on CT scan with demonstration of fat within the tumor. Endobronchial lipoma was diagnosed and a sleeve lobectomy of the right upper lobe bronchus was performed. The pathological diagnosis was submucosal lipoma. The patient's symptoms improved during follow-up of more than 1 year. CT scan can be used to diagnose endobronchial lipoma and can help in the development of a management plan.

Aged↗

[Rounded atelectasis: a follow up of 10 years by CT].

We report the case of a 69-year-old man who presented with a rounded atelectasis (RA). During a 10-year follow-up by Computed Tomography (CT), the lobe showed a progressive shrinkage, and a moderate increase in size of the lesion led to a percutaneous biopsy which confirmed the diagnosis. RA is an unusual form of lung consolidation. The major cause of RA is asbestosis. RA is usually asymptomatic and may simulate a pulmonary neoplasm on chest Xray. The diagnosis is made by CT, demonstrating the pathognomonic "comet tail sign". No treatment is required.

Aged↗

[Chronic atelectasis--an indication for lung resection in early childhood?].

Between 1980 and 1989, 69 children underwent lung resection in our department. 45 of them (25 boys, 20 girls, age 0-9 years) presented with atelectatic areas of the lung parenchyma, which had been demonstrated preoperatively in only 76%. Resections were performed for bronchial malformations (n = 7), sequestration (6), cysts (6), aspiration (1), pyocele following pulmonary artery ligation (1), upper lobe torsion (1), chronic pneumonia and/or bronchiectasis (14) and lobar emphysema with lung compression (10). The overall mortality was 4/45. Indications are discussed with special reference to the persistent or recurrent atelectasis.

Adolescent↗

[Clinical and pathologic features of rounded atelectasis in patients with empyema].

Rounded atelectasis (RoA) is an uncommon pulmonary condition presenting as a peripheral round opacity on a chest roentgenogram. Six cases of empyema who underwent regional lung and pleural resection, had local atelectatic induration beneath the pleura. Their clinical and pathologic features were examined. Five cases had past histories of pulmonary tuberculosis with therapeutic pneumothorax, and one other case had tuberculous pleuritis. Five of seven atelectatic indurations displayed RoA on preoperative plain radiography ++ and/or CT and on soft X-ray films of resected lung preparations. With pathological examinations, the pleura showed one or several indentations, often with deep invaginations into the pulmonary parenchyma. In these regions, the appearance was occasionally more complex due to several small folds emanating from the larger fold. Outside the pleural folds, there was dense fibrous thickening. Fibrosis of the pleural interstitial layer itself was mild. Lung parenchyma adjacent to the folded pleura appeared collapsed with mild interstitial fibrosis. These findings lead to the hypothesis that RoA may result from pleural invaginations occuring after pleural effusion or therapeutic pneumothorax and from fibrous adhesions of the outer regions.

Aged↗

[Round atelectasis: infrequent cause of solitary pulmonary nodule].

Two cases of round atelectasis are reported. One had an asbestiform origin, with lingular localization and pathological confirmation. The other was located in the posterobasal segment of the left lower lobe, and it was presumably caused by pleural tuberculosis. In both patients the characteristic radiological findings were present, with an outstanding "comet's tail" sing. The outcome of both patients was satisfactory. Emphasis is made on the usefulness of noninvasive diagnostic investigations, such as conventional pulmonary and computed tomography (CT) of the torax, which, in conjunction with an adequate anamnesis, permit the correct diagnosis and may prevent surgical exploration.

Aged↗