Atelectasis and collapse of the lungs, Pneumothorax

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Atelectasis:

Atelectasis is classified into three main forms:

1. Obstruction/resorptive atelectasis - caused by some obstruction in the airways such as mucus, a tumor, or foreign body aspiration that leads to no air reaching the alveoli distal to the obstruction. When no air is reaching, the present air is gradually absorbed causing alveolar collapse.
2. Compression atelectasis - caused by accumulation of air, fluid or blood in or within the pleural cavity. Common causes being pleural effusion, pneumothorax.
3. Contraction atelectasis - local or diffuse fibrosis in pulmonary tissue reduces lung expansion.

Atelectasis

The most common cause is surgery, shallow breathing during anesthesia can lead to blockages or lack of air to the alveoli.

Other causes as previously mentioned are pneumothorax, inhalation of foreign objects, tumors, fibrosis of lungs, mucus plugs and underlying illnesses such as COPD, ARDS, or pneumonia.

Atelectasis doesn't have symptoms of its own, there may be symptoms present of the underlying condition that is causing it in the first place, like COPD for example, or there can be symptoms due to hypoxemia (due to less perfusion) such as dyspnea, coughing, chest pain, tachypnea, cyanosis.

Typically, chest X-rays are the most common method of diagnosis, however CT or bronchoscopy may also be used in some cases.

Atelectasis (except when its caused by contraction) is potentially reversible and should be treated promptly to avoid complications because of hypoxemia or superimposed infection of the collapsed lung. Treatments depend on the cause and extent of the collapse and can include:

• deep breathing exercises
• If its caused by an obstruction, then removing it
• Bronchodilators
• Treatment of the lung condition causing it

Pneumothorax:

Pneumothorax, commonly referred to as punctured lung, refers to the presence of air in the pleural sac.

There are two main types of pneumothorax of which there are subtypes; spontaneous and traumatic.

Spontaneous pneumothorax occurs without injury:

• Primary is where there is no underlying disease that can cause the collapsed lung, this happens if abnormal air pockets in your lungs release air into the cavity.
• Secondary is when there is an underlying disease, when pulmonary lesions close to the surface of the lungs, such as emphysema or lung abscess, burst and release air into the pleural cavity

Traumatic pneumothorax occurs due to an injury such as blunt force trauma, a stab or gunshot wound to the chest or a broken rib, or it can be when the lung is punctured in a medical procedure for example a biopsy.

If there's a cut that acts as a one way valve, allowing air to get in but not leave, that's called a tension pneumothorax. It increases intrapleural pressure, and may shift the mediastinum.

Symptoms include chest pain on one side during inhalation, cough, tachycardia, tachypnea, cyanosis, dyspnea.

It is diagnosed typically through chest X rays and CT, after physical examinations of course. In some cases an arterial blood gas test may also be used.

Treatment usually includes oxygen therapy or thoracocentesis, where a needle is placed between your ribs to allow the air to leave.