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Atelectasis: description

In atelectasis, parts of the lungs or the entire lungs are evacuated. The term comes from the Greek and means something like "incomplete expansion". The condition primarily affects the smallest air-conducting units of the lungs, the alveoli, also known as alveoli in technical terms. The alveoli have a very important function because this is where the oxygen exchange takes place. The alveoli are surrounded by a fine network of tiny blood vessels, where red blood cells flowing past absorb oxygen from the air. If the alveoli collapse, the area in question is no longer available for oxygen exchange. Atelectasis is therefore a serious condition.

Doctors basically differentiate between two forms of atelectasis:

  • Primary or congenital atelectasis: This form only affects newborns or premature babies and is therefore also known as fetal atelectasis.
  • Secondary or acquired atelectasis: This occurs as a result of another illness.

Atelectasis: symptoms

Atelectasis restricts lung function. The symptoms that result from this depend, among other things, on the size of the affected lung segment and whether the atelectasis developed suddenly or gradually. The respective causes for the collapse of the lungs also shape the symptoms.

Atelectasis can affect the lung no gas exchange take place more. As a result, the oxygen content in the blood drops - the organism tries to compensate for this condition by accelerating breathing and increasing the heart rate. As a sign of a low oxygen level in the blood, the skin of some affected people turns bluish - doctors also refer to this symptom as cyanosis.

If the atelectasis occurs suddenly, for example because the airways are blocked, those affected complain of severe shortness of breath (dyspnoea) and, in some cases, sharp pain in the chest. If large areas of the lungs collapse, circulatory shock can also occur. The blood pressure suddenly drops sharply and the heart beats very quickly (tachycardia).

Atelectasis that develops slowly and only affects smaller areas of the lungs, on the other hand, causes only mild symptoms. Some of those affected notice that they are short of breath and quickly become out of breath, especially when exerting themselves. It also happens that minor atelectasis goes unnoticed.

Symptoms of congenital atelectasis, as it occurs in premature babies, often appear immediately after birth or within the first hours of life. The skin of the affected premature babies turns bluish. You breathe quickly; the areas between the ribs and above the breastbone are drawn in when you inhale and the nostrils move more intensely. Affected children often moan as they exhale as an expression of their shortness of breath.

Atelectasis: causes and risk factors

Congenital and acquired atelectasis can have many different causes.

The following causes come for the congenital atelectasis in question:

  • Lung immaturity: This phenomenon particularly affects premature babies. The alveoli usually contain a substance that lowers the surface tension of liquids, called a surfactant. If this substance is missing, the alveoli, which are covered by a thin film of liquid, collapse. Only in the last few weeks before the birth does the lungs fully mature and form sufficient amounts of surfactant. However, if a child is born prematurely, there is a deficiency in this substance and the lungs cannot develop properly after the birth. Doctors then also speak of respiratory distress syndrome in premature babies.
  • Obstructed airways: If the newborn inhales mucus or amniotic fluid, the lungs cannot properly fill with air. Atelectasis can also result from malformations that hinder the airflow in the airways.
  • Disturbance of the respiratory center: If the respiratory center in the brain is damaged (for example due to a cerebral hemorrhage), the reflex to take a breath may be missing after the birth.
  • Diaphragmatic hernia: The diaphragm (the muscle plate that separates the chest from the abdomen) is malformed here and has a gap. This allows abdominal organs to slide into the rib cage and compress the lungs so much that they have no room to inflate after birth.

Causes of a acquired atelectasis are:

  • Obstructive atelectasis: Here the airways are blocked, e.g. by a tumor, thick mucus or a foreign body.
  • Compression atelectasis: The lungs are compressed from the outside, e.g. by an effusion of liquid in the chest or a very enlarged lymph node.
  • Relaxation atelectasis: The cause of the atelectasis here is a so-called pneumothorax. There is a small, fluid-filled gap (pleural gap) between the skin that covers the lungs (lung pleura) and the pleura, which lies against the inside of the chest wall. Both surfaces adhere closely to one another through adhesive forces - this means that the lungs follow the breathing movements of the chest. In the case of a pneumothorax, air enters the pleural space - the elastic lung tissue then follows its own tissue tension and the lung section in question collapses. A pneumothorax can result, for example, from piercing injuries to the chest or from various lung diseases.

Atelectasis: examinations and diagnosis

Usually typical symptoms point to atelectasis - in many cases the underlying disease also suggests that there is a dysfunction of the lungs. Doctors expect a premature baby to have breathing problems. Immediately after the birth, the midwife and pediatrician pay particular attention to the baby's breathing, skin color, heart rate, reflexes and muscle tension. Abnormalities such as bluish skin color or increased or weak breathing indicate that there are problems.

If a child is born before the 37th week of pregnancy, doctors speak of a premature birth. The premature baby's still immature lungs are one of the most common reasons for complications after childbirth. Usually a pediatrician who specializes in treating premature babies (neonatologist) will diagnose atelectasis. An X-ray examination confirms the diagnosis and also shows the degree of immature lungs.

In the case of acquired atelectasis, the diagnosis of the underlying disease is usually in the foreground. To do this, the doctor first conducts a detailed discussion with the patient and asks him about his symptoms and known diseases. He then monitors the patient's lungs with a stethoscope. In the case of atelectasis, the normal breathing sounds are weakened.

If the doctor taps the chest with his fingers, the sound is muffled. Here, too, the X-ray examination provides definitive evidence of whether there is atelectasis. Depending on the cause (e.g. a lung tumor, blood or fluid effusions in the chest, foreign bodies in the airways), further examinations, such as a blood test or computer or magnetic resonance tomography, may follow.

Atelectasis: treatment

Therapy for atelectasis is primarily based on its causes. The primary goal is to restore lung function as soon as possible and to supply the body with sufficient oxygen. If, for example, a foreign body or mucus plug in the airways is the reason for the collapsed lung area, it must be removed or suctioned accordingly.

A lung tumor usually requires surgery to remove the tumor. In a pneumothorax, air has penetrated the intercostal space, causing a section of the lung to collapse. Surgical intervention is required in some cases, but mild forms do not always have to be treated.

Congenital atelectasis is mostly based on insufficient lung maturity or a lack of surfactant. To compensate for this deficiency, premature babies receive this substance as a drug. If the breathing problems are very pronounced, the baby is artificially ventilated through a thin tube in the windpipe (tube).

Atelectasis: Prevention

One acquired Atelectasis cannot be prevented by a specific measure. Congenital forms, such as respiratory distress syndrome in premature babies, can, however, be counteracted to a certain extent. Pregnant women who are at risk of premature birth are given a drug that promotes lung maturation in the unborn child. This is a so-called corticosteroid; doctors usually use the active ingredient betamethasone here. They also try to delay the birth as long as possible by using contraceptive agents.

Read more about the therapies

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Atelectasis: disease course and prognosis

Atelectasis is not an independent disease, but a side effect that can have many different causes. A general statement about the course or the prognosis is therefore not possible. Rather, the underlying disease decides how the disease will progress. If this can be treated well, the function of the lungs can usually be restored.

In premature babies, the prognosis depends on numerous factors. Basically, the earlier a child is born, the more immature the lungs. However, it is not possible to predict which problems will arise in premature babies, so even extremely premature babies can deal with one Atelectasis develop well, while a later date of birth is no guarantee of a complication-free course.

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