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What To Know About Atelectasis

Atelectasis is when the airways or air sacs in the lungs collapse or do not fully expand. Symptoms can include shallow breathing, coughing, and wheezing. Treatment may involve medications, breathing exercises, or surgery.

Sometimes, atelectasis may also be called total or partial lung collapse. Atelectasis may affect both lungs or only part of them, with several causes and types.

Around 90% of people who are placed under general anesthetic during surgery experience atelectasis afterward. Atelectasis is usually reversible. However, without medical care, it can lead to potentially fatal complications

In this article, we look at the types, causes, symptoms, diagnosis, treatment, and outlook of atelectasis.

The types of atelectasis sit within four categories based on the conditions that cause them.

Nonobstructive

Types of nonobstructive atelectasis include:

Compression: Due to increased pressure on the lungs.

Adhesive: Caused by dysfunction or deficiency of pulmonary surfactant. This is a soap-like substance that creates surface tension in the air sacs, helping them stay open.

Cicatrization: Occurs due to scarring, which causes the lungs to shrink.

Relaxation: The loss of contact between the membranes connecting to the chest wall, called the parietal pleura, and the membranes covering the lungs, known as the visceral pleura.

Replacement atelectasis: Occurs when tumors fill or replace the air sacs.

Obstructive

Obstructive atelectasis is also called resorptive atelectasis.

An obstruction triggers a partial or complete lack of ventilation to the impacted area, though gas uptake into the blood still occurs.

When all of the gas is absorbed, the air sacs eventually collapse as the obstruction prevents more gas from entering.

Postoperative

Postoperative atelectasis usually develops within 72 hours of receiving general anesthesia because of altered gas exchange during sedation.

Rounded

Rounded atelectasis is less common than other forms.

It occurs due to the folding of the lung tissue to the membranes covering the lungs and connecting them to the chest wall, known as the external pleura.

People may refer to both atelectasis and pneumothorax as collapsed lung.

However, although pneumothorax can cause atelectasis, they are different conditions.

Pneumothorax occurs when air collects between the inner and outer membranes, or pleura, of the lungs. This triggers pressure that can cause the lungs to collapse.

The potential causes of atelectasis depend on whether it is a nonobstructive or obstructive type.

Nonobstructive

Causes of nonobstructive atelectasis include:

Surgery

Sedating medications for surgery, such as general anesthetic, change the way the lungs work, as well as the flow of gas exchange and ventilation. This can cause lung tissues or airways to collapse.

Certain types of surgeries may also make it more difficult or painful to breathe deeply. This interferes with gas exchange and ventilation. About 90% of people who are given general anesthesia develop atelectasis.

Pleural effusion

Pleural effusion occurs when fluid accumulates between the lungs' inner and outer membranes, which can cause a partial or total collapse. This condition is commonly caused by acquiring an infection, inflammatory diseases, and malignant (cancerous) tumors.

Lung damage

Lung damage or scarring can cause the lungs to shrink or become unable to expand fully. Conditions, such as tuberculosis, fibrosis, and other chronic destructive lung conditions, often lead to lung damage.

Chest tumors

Either cancerous or benign (non-cancerous) tumors can put pressure on airways and lung tissues, potentially causing them to collapse.

Surfactant conditions

A deficiency or dysfunction can reduce the surface tension in the air sacs, causing them to collapse. This is often due to conditions that arise from premature birth, including respiratory distress syndrome and acute respiratory distress syndrome.

Airways or lung tissue defects

Abnormalities in airways or lung tissues can interfere with gas exchange, ventilation, surface tension, and how the lungs connect to the chest wall or fit within the chest cavity.

Pleurisy

Pleurisy occurs when the lung pleura become inflamed, rough, and sticky. They rub against one another instead of smoothly gliding during inhalation and exhalation.

This condition may occur due to inflammatory diseases, infection, tumors, or other conditions known to cause inflammation.

Obstructive

Obstructive types of atelectasis occur when an object or abnormal growth physically blocks an airway or increases pressure on lung tissues or airways.

Common causes of obstructive atelectasis include:

inhaling a foreign object or getting one lodged in the airways or lung tissues

tumors in the airways or lung tissues

growths or objects in lung tissues and airways

mucus buildup that causes a so-called mucus plug to block the airways

If a small portion of the lung or airways become affected, atelectasis may not cause any obvious symptoms.

However, when the condition impacts a significant portion of the lung or airways, common symptoms of atelectasis include:

shallow breathing

coughing

wheezing or trouble breathing

fever

reduced or absent breathing sounds

crackling when breathing

excess mucus or sputum

reduced chest expansion during inhalation

A doctor will normally diagnose atelectasis by asking someone about their symptoms, underlying conditions, medical history, and by performing a physical exam.

A doctor will also use the results from a chest X-ray or other imaging of the chest, such as computed tomography or ultrasound scan.

They may also diagnose the condition using bronchoscopy. This involves placing a small tube with a camera and light through the windpipe, bronchi, and bronchioles to see inside the lung airways.

Common treatments for atelectasis include:

inhaled medications

breathing and coughing exercises

assistive breathing machines

sitting upright

getting up and moving around soon after surgery

A doctor may also perform surgery for one or more of the following reasons:

removing fluid

removing obstructions

removing growths

correcting anatomical structures

reopening collapsed tissues

There are several factors that healthcare professionals believe increase the risk of developing atelectasis, especially following surgery. They include:

administration of general anesthesia, sedatives, or muscle relaxants

obesity

pregnancy

smoking

improper pain control

thoracic or cardiopulmonary procedures

sleep apnea

lung conditions such as asthma, cystic fibrosis, or chronic obstructive pulmonary disease

Some methods may also help prevent the risk of developing atelectasis, especially before surgery or medical procedures involving sedation.

Ways to prevent atelectasis include:

quitting smoking

maintaining a moderate weight

using assistive breathing or lung-pressure machines

practicing breathing exercises

treating lung conditions or those that interfere with airflow

ensuring proper pain management

sitting upright instead of laying down

Atelectasis usually resolves itself with time or treatment, while lung or airway collapse is reversible.

For example, most people who develop atelectasis due to surgery recover 24 hours afterward.

However, if atelectasis is left undiagnosed or untreated, serious complications can develop. These can be potentially fatal, including but not limited to:

fluid buildup in the lung, pleural space, or chest

respiratory infections such as pneumonia

respiratory failure

The outlook for someone with atelectasis depends on how serious their condition is, the root cause, and any additional underlying conditions.

Atelectasis occurs when the air sacs, or alveoli, collapse or cannot fully expand.

The condition typically develops after a person goes under general anesthetic, or if they have a condition that impacts the lungs or structures and organs surrounding them.

Most people recover from atelectasis with proper treatment within 24 hours. However, without medical intervention, atelectasis can lead to serious complications, including death.

Acute Sinusitis: Everything You Should Know

This common sinus inflammation is often caused by a cold or other viral injection. Usually your symptoms will go away within 10 days, but can last up to 4 weeks. A health professional can help diagnose and help you address this with at-home remedies or other treatments.

A stuffed nose and pressure on our cheekbones, near the eyes, or over the forehead may mean that you have acute sinusitis.

Acute sinusitis, also called acute rhinosinusitis, is a short-term inflammation of the membranes that line your nose and surrounding sinuses. This impedes your ability to drain mucus from your nose and sinuses.

As a common health issue affecting 1 in 8 adults each year, acute sinusitis is most often caused by a cold or viral infection. But it can also be due to noninfectious causes, including seasonal allergies, nasal issues, or health conditions like cystic fibrosis.

This article will explain more about acute sinusitis, causes, and how your healthcare team can help diagnose and treat this nasal and sinus inflammation.

Illnesses and conditions that can cause or lead to acute sinusitis include:

An infected tooth could also cause acute sinusitis, as bacteria can spread from the infected tooth to the sinuses.

The following factors can increase your risk of developing acute sinusitis:

intranasal allergies

nasal passage abnormalities, such as a deviated septum or nasal polyps

tobacco smoking or frequent breathing in of other pollutants

large or inflamed adenoids

spending a lot of time in a day care, preschool, or other areas where infectious germs are frequently present

activities that result in pressure changes, such as flying and scuba diving

a weakened immune system

cystic fibrosis

Symptoms of acute sinusitis include:

nasal congestion

thick yellow or green mucus discharge from the nose

sore throat

a cough, usually worse at night

drainage of mucus in the back of your throat

headache

pain, pressure, or tenderness behind your eyes, nose, cheeks, or forehead

earache

toothache

bad breath

reduced sense of smell

reduced sense of taste

fever

fatigue

Diagnosing acute sinusitis usually involves a physical exam. Your doctor will gently press over your sinuses with their fingers to identify an infection. The exam may involve looking into your nose with a light to identify inflammation, polyps, tumors, or other abnormalities. Your dotor may also take a culture to help diagnose.

Your doctor may also perform the following tests to confirm a diagnosis:

Nasal endoscopy

Your doctor may look into your nose using a nasal endoscope. This is a thin, flexible fiber-optic scope. The scope helps your doctor identify inflammation or other abnormalities in your sinuses.

Imaging tests

Your doctor may order a CT scan or MRI to look for inflammation or other nose or sinus abnormalities. A CT scan uses rotating X-rays and computers to take detailed, cross-sectional images of your body. An MRI takes 3-D images of your body using radio waves and a magnetic field. Both these tests are noninvasive.

Most cases of acute sinusitis can be treated at home:

A moist, warm washcloth: Hold it over your sinuses to ease pain symptoms.

A humidifier: This can help keep the air moist.

Saline nasal sprays: Use them several times a day to rinse and clear your nasal passages.

Stay hydrated: Drink plenty of fluids in order to help thin mucus.

Over-the-counter (OTC) nasal corticosteroid spray: Sprays such as fluticasone propionate (Flonase) can reduce intranasal and sinus inflammation.

OTC oral decongestant therapy: These therapies, such as pseudoephedrine (Sudafed), can dry up mucus.

OTC pain relievers: Medications you can buy in stores OTC like acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can help relieve sinus pain.

Sleep with your head elevated: This encourages your sinuses to drain.

Prescription medications

Your doctor may prescribe prescription antibiotic therapy if they think you have acute bacterial sinusitis.

Allergy shots

If intranasal allergies are thought to be related to your bouts of acute sinusitis, your doctor may have you see an allergist. The allergist can see if other allergy treatments or possibly shots would help you deal with allergic sinusitis more easily.

Surgery

In some cases, surgery may be necessary to treat the underlying cause of acute sinusitis. Your doctor may perform surgery to:

remove nasal polyps or tumors

correct a deviated nasal septum

open the normal passageways to drain your sinuses

removing an infected or impacted tooth

The following alternative treatments may help relieve your acute sinusitis symptoms:

Herbs

Nasturtium herb and horseradish may be beneficial for relieving some acute sinusitis symptoms. This therapy produced a lower risk for adverse side effects compared to standard antibiotic therapy, per a German study published in 2007. Ask your doctor about safety and dosages.

Acupuncture and acupressure

While no hard scientific evidence exists to confirm their effectiveness in treating this condition, some people report that acupuncture and acupressure provide some relief for acute sinusitis caused by allergies.

Most cases of acute sinusitis clear up with home treatment, within a week or 10 days. Other people may experience symptoms for a few weeks.

But sometimes acute sinusitis doesn't clear up and becomes subacute or chronic sinusitis.

Subacute sinusitis lasts 4-8 weeks total. However, chronic sinusitis can last more than 8 weeks.

In very rare cases, acute infectious sinusitis can lead to an infection that spreads to your eyes, ears, or bones. It could also cause meningitis.

Overall, complications from acute sinusitis are rare but they do develop.

Call your doctor or healthcare team if you experience:

a severe headache that doesn't respond to medication

a high-grade fever

vision changes

changes in consciousness

mentation

These may be signs that the acute infection has spread outside your sinuses.

You may be able to prevent getting acute sinusitis. Here's how:

eat a healthy diet to keep your immune system strong.

avoid cigarette smoke and other air pollutants.

minimize your contact with people who have acute respiratory or sinus infections.

wash your hands often and before meals.

use a humidifier in dry weather to help keep the air and your sinuses moist.

get a yearly flu vaccine.

treat allergies promptly.

take oral decongestant therapy when you have nasal congestion.

Acute sinusitis is a common condition that as many as 1 in 8 people experience. It's most often caused by a cold, but can also be caused by allergies, nasal issues, or conditions like cystic fibrosis.

This usually doesn't last longer than 10 days and resolves on its own, but symptoms can last up to 4 weeks. You can treat it with simple at-home remedies or over-the-counter pain relievers, as well as prescription medications or surgery. You may also try certain herbs and acupuncture.

You may want to consult your healthcare team if you experience a fever or more severe pain, as that can be a signal that your acute sinusitis is worsening.

Acute Pancreatitis

Acute pancreatitis is an inflammation of the pancreas that develops quickly. Some acute pancreatitis symptoms include sudden pain in the upper abdomen, nausea, and swelling in the abdomen.

Some mild cases resolve without treatment, but severe cases need treatment to prevent life-threatening complications.

The pancreas is a long, flat gland behind the stomach in the upper abdomen. It produces digestive enzymes and hormones, which regulate how the body processes glucose, for instance.

Pancreatitis is inflammation of the pancreas. It can either be acute, in which case short-term inflammation develops suddenly, or chronic, in which case it is reoccurring or persistent.

The most common cause of acute pancreatitis is gallstones, which can become lodged in a bile or pancreatic duct and cause inflammation. Other common causes include excessive alcohol use, genetic conditions, and the use of certain medications.

Typically, a person has a sudden onset of pain in the center of their upper abdomen, below the breastbone, or sternum. The pain may intensify and become severe, and it may spread into the back. Leaning forward may ease it, but lying down or walking can make it worse. Anyone with unrelenting pain should receive medical attention.

The following symptoms may also occur:

vomiting

nausea

diarrhea

swelling and tenderness of the abdomen

a rapid pulse

a fever

Treatment for acute pancreatitis depends on its severity. For people with mild cases, the risk of complications is low, and the symptoms may resolve after a few days of rest and treatment. In severe cases, the risk is significant.

Treatment for mild acute pancreatitis

The aim is to maintain bodily functions and ease the symptoms while the pancreas heals itself. The treatment may include:

Painkillers: Mild acute pancreatitis can be moderately or severely painful.

Nasogastric tubes: These can remove excess liquid and air to relieve nausea and vomiting.

Bowel rest: The gastrointestinal tract needs to rest for a few days, so the person will not have any food or drink by mouth until their condition improves.

Preventing dehydration: Dehydration often accompanies pancreatitis, and it can worsen the symptoms and complications. Healthcare professionals usually provide fluid intravenously for the first 24–48 hours.

A person can usually return from the hospital after about 5–7 days.

Treatment for severe acute pancreatitis

Severe cases often involve some tissue death, or necrosis. This increases the risk of sepsis, a severe bacterial infection that can affect the whole body. Sepsis can lead to multiorgan damage or failure.

Severe acute pancreatitis can also cause hypovolemic shock. This involves severe blood and fluid loss leaving the heart unable to pump enough blood to the body. If this happens, parts of the body can rapidly become deprived of oxygen. This is a life threatening situation.

Treatment for this kind of pancreatitis includes:

Treatment in the intensive care unit (ICU): There, injected antibiotics can help prevent an infection from developing in the dead tissue.

Intravenous fluids: These help maintain hydration and prevent hypovolemic shock.

Feeding tubes: These provide nutrition, and taking this course early may improve the outcome.

Surgery: In some cases, the medical team may recommend surgical removal of the dead tissue.

The patient will stay in the ICU until there is no longer a risk of organ failure, hypovolemic shock, or sepsis.

Treating gallstones

If gallstones are responsible for acute pancreatitis, a doctor may recommend surgery or endoscopic retrograde cholangiopancreatography (ERCP) after the pancreatitis improves. ERCP involves using imaging to diagnose and treat health conditions that affect the bile and pancreatic ducts.

After surgery to remove gallstones, a person may need to have a diet that helps reduce blood cholesterol. This is because excess cholesterol encourages the growth of gallstones.

Also, when gallstones have caused pancreatitis, the American Gastroenterological Association recommends considering surgery to remove the gallbladder to prevent future attacks.

Treating alcohol misuse

If doctors determine that alcohol misuse has caused acute pancreatitis, they may recommend a treatment program for alcohol misuse.

Gallstones and alcohol misuse are the most common causes of acute pancreatitis.

Gallstones

Gallstones are small, pebble-like formations that develop in the gallbladder, often when there is too much cholesterol in the body's bile.

Sometimes, gallstones become lodged as they travel through bile ducts into the intestines. This blockage affects the pancreas and prevents it from releasing its enzymes into the intestines.

Alcohol misuse

Researchers and medical experts have linked ongoing, substantial consumption of alcohol to a higher risk of acute and chronic pancreatitis.

While the nature of this link remains unclear, alcohol may increase the production of substances that damage pancreatic tissue and lead to severe inflammatory responses.

Other causes

Other possible causes of acute pancreatitis include:

infections

some autoimmune conditions, such as lupus and Sjögren's disease

specific genetic mutations

trauma or injury to the pancreas

high triglyceride levels in the blood

high calcium levels in the blood

certain medications

For a few days during treatment, a person may be unable to eat or need to avoid solid foods. In the hospital, some people require a feeding tube.

When the person starts eating again, the doctor may recommend a healthy low-fat diet with small, regularly paced meals. It is important to drink plenty of fluids, but limit caffeine and avoid alcohol.

Pancreatitis can lead to potentially fatal complications. These can include:

the obstruction of a bile or pancreatic duct

leakage from a pancreatic duct

pseudocysts, with a risk of rupture, hemorrhage, or infection

damage to the pancreas

a buildup of fluid around the lungs

a blockage in a vessel that drains blood from the spleen

sepsis

hypovolemic shock

Heart, lung, and kidney failure may also occur. Without treatment, these can lead to death.

Anyone with symptoms of acute or chronic pancreatitis should receive medical care as soon as possible.

First, the doctor asks about symptoms and examines the person's abdomen. If certain areas are sensitive to the touch, this could indicate acute pancreatitis.

In a person with this condition, the abdominal wall muscles are rigid, so when the doctor listens to the abdomen with a stethoscope, there may be very few or no intestinal sounds.

Blood tests

If blood levels of amylase and lipase are higher than normal, the doctor usually sends the person to the hospital. This is because the pancreas produces elevated levels of both chemicals in response to tissue damage, and these enzymes then leak into the blood stream.

However, if the blood test happens outside the first or second day of the illness, the results may be inaccurate. This is because lipase and amylase levels are highest in the first few hours of the illness and return to normal after a few days.

Further testing in the hospital

To determine the cause and risk of complications, the medical team in the hospital may perform:

An ultrasound scan: This involves using high-frequency sound waves to create an image of the pancreas, gallbladder, and their surrounding structures.

Contrast-enhanced CT scan: This takes pictures of the same area from many angles and combines them to produce a 3D image. It can help identify inflammation of the pancreas, fluid collection, and any changes in the density of the organ.

Chest X-ray: This can show areas of collapsed lung tissue or accumulation of fluid in the chest cavity.

ERCP: This involves using an endoscope, a thin, flexible tube with a camera, to view the digestive system and determine the exact locations of any gallstones.

Acute pancreatitis usually resolves in a few days with treatment. A person may need to receive this in a hospital, depending on the cause and severity of the condition.

In the U.S., acute pancreatitis is a leading cause of hospital admission due to gastrointestinal disease, resulting in roughly 300,000 hospitalizations a year.

Evidence suggests that there were roughly 2.8 million cases of acute pancreatitis globally in 2019. While there were substantial differences in incidence and mortality across regions, the condition affected roughly 35 in every 100,000 individuals. Approximately 115,053 deaths resulted from acute pancreatitis during that year, with a mortality rate of 1.4 per 100,000 people.

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