Infection by the respiratory syncytial virus (RSV) and other viral infections in young children can cause multiple areas of atelectasis.
Mucus plugs are a frequent factor that predisposes to atelectasis. The massive collapse of one or both lungs is usually a postoperative complication, although it can also be due to other causes, such as trauma, asthma, pneumonia, tension pneumothorax, aspiration of foreign material and paralysis, or after extubation (removal of the endotracheal tube). Massive atelectasis is usually caused by a combination of factors such as immobilization or decreased use of the diaphragm and respiratory muscles, obstruction of the bronchial tree and abolition of the cough reflex.
Can Atelectasis Cause Fever?
Symptoms vary depending on the cause and extent of atelectasis. A small area is probably asymptomatic (absence of symptoms).
Although it was previously believed that atelectasis by itself can cause fever, no association between atelectasis and fever has been demonstrated.
When atelectasis occurs in a large area of the previously normal lung, especially if it does so suddenly, dyspnea with rapid and superficial breathing, tachycardia, cough and, frequently, cyanosis occur. If the obstruction is removed, these symptoms will disappear quickly. The physical examination reveals a decrease in the amplitude of the thoracic movements, a decrease in the intensity of respiratory sounds and the presence of coarse crackles. Respiratory sounds will be attenuated or completely absent in the areas of extensive atelectasis.
Massive pulmonary atelectasis usually causes dyspnea, cyanosis, and tachycardia. The affected child will be very anxious and, if old enough, will report chest pain. The thorax is flattened on the affected side, where there is also a decrease in the amplitude of respiratory movements, dullness to percussion and weak or absent respiratory sounds. Postoperative atelectasis usually manifests itself in the 24 hours following the operation, although it may take several days to appear.
Acute lobular atelectasis is common in patients treated in the intensive care unit. If it is not detected it can alter the gaseous exchange and produce a secondary infection, with the consequent pulmonary fibrosis. Initially, hypoxemia is due to an imbalance between ventilation and perfusion. Unlike the atelectasis of adult patients, in those who have mainly affected the lower lobes and especially the lower left lobe, in 90% of children the upper lobes are affected, and in 63% of cases, it is the right. It is also described a high incidence of upper lobe atelectasis, especially right, in patients with atelectasis that are treated in neonatal intensive care units. This high incidence may be due to the displacement of the endotracheal tube into the main right bronchus, where it produces obstruction or inflammation of the bronchus of the right upper lobe.
The diagnosis of atelectasis can be made with a chest x-ray. Typical findings are a loss of volume and displacement of the fissures. The typical manifestations are opacity with the appearance of mass and atelectasis in a rare location. Lobular atelectasis can be associated with pneumothorax.
In asthmatic children, chest radiograph shows an alteration in 44% of cases, compared with a frequency of 75% in high resolution computed tomography. Children with asthma and atelectasis have a higher incidence of right middle lobe syndrome, asthma exacerbations, pneumonia, and upper respiratory tract infections.
After the aspiration of a foreign body, atelectasis is one of the most frequent radiological findings. The location of the atelectasis usually indicates the location of the foreign body. Atelectasis is more frequent when the aspiration of the foreign body has occurred more than 2 weeks before.
Bronchoscopic examination shows the collapse of the main bronchus when the obstruction is located in the tracheobronchial junction, and may also reveal the nature of the obstruction.
Massive pulmonary atelectasis is diagnosed on chest radiography. The typical findings are the elevation of the diaphragm, narrowing of the intercostal spaces and the displacement of the mediastinum and heart structures to the affected side.
The causes of atelectasis can be multiple; among them is the external compression of the pulmonary parenchyma, obstruction at different levels of the respiratory tract, paralysis, and respiratory deterioration.
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