Atelectasis

Atelectasis is when part or all of your lung deflates or collapses. Your lung is like a collection of balloons (air sacs, or alveoli) that fill with air. Atelectasis (pronounced “at-uh-LEK-tuh-sis”) occurs when some of these balloons lose air. It’s a common condition that may occur due to:

• Chest or belly surgery
• A blocked airway (obstruction)
• A chest injury
• Being in bed sick and not taking deep breaths, especially when mucus accumulates in your airways

When you breathe in (inhale), your lungs fill with air. Air travels to the alveoli, where oxygen moves into your blood. Your blood delivers oxygen to organs and tissues throughout your body. But if your alveoli don’t get enough air, it can affect how well you breathe. This affects how much oxygen circulates through your body.

A collapsed lung sounds scary. And in some cases, it can be severe and even life-threatening. But atelectasis often goes away on its own. Depending on the cause, though, you may need treatment, like respiratory therapy, medications or a medical procedure.

Types

Four of the most common types of atelectasis include:

• Compressive atelectasis: This is when something around your lung pushes against it and causes it to collapse. Examples include fluid, air, blood or a tumor.
• Resorptive/obstructive atelectasis: A blockage prevents air from filling up your alveoli. Examples include mucus, a tumor or something you accidentally breathe in. When the air in your alveoli enters your bloodstream and no new air comes in, the alveoli collapse.
• Microatelectasis: You don’t have enough surfactant in your alveoli. Surfactant is a layer of lipids and proteins that line the surface of your alveoli. They help protect your lungs from collapsing. Preterm babies and people with acute respiratory distress syndrome (ARDS) may not have enough surfactant.
• Contraction atelectasis: Lung scarring (fibrosis) keeps your alveoli from opening properly.

Providers may also use different names to describe the location, appearance and severity of the alveoli collapse. These may include:

• Bibasilar atelectasis: Partial collapse of the lower part of your lungs, usually from not breathing deeply or being in bed and having your belly push up on your lungs.
• Rounded atelectasis: The thin membrane that lines your chest wall and cushions your lungs (pleura) “folds” and causes your lung to collapse.
• Gravity-dependent atelectasis: When gravity causes the lowest parts of your lungs to deflate. For example, when lying on your back.
• Subsegmental atelectasis: This is the mildest form of atelectasis. It usually doesn’t cause any symptoms and goes away quickly.

Symptoms of atelectasis

It usually doesn’t cause symptoms, although it may reduce your blood oxygen levels. Some causes of atelectasis can cause symptoms like:

• Shortness of breath (dyspnea)
• Coughing
• Chest pain
• Rapid breathing (tachypnea)
• Blue or gray skin, lips or nails (cyanosis)

What causes atelectasis of the lungs?

Surgery is the most common cause of atelectasis. Healthcare providers use anesthesia to keep you asleep during surgery. Normally, you’ll take deep breaths or cough without thinking. This helps keep your alveoli open. But when you’re under anesthesia, you don’t breathe deeply enough to completely fill your lungs. You also don’t cough to clear your lungs of mucus. This can lead to blockages that prevent air from filling your alveoli.

Other atelectasis causes include:

• Taking shallow breaths due to chest pain
• Lying in bed with your belly pushing up against your lungs
• A buildup of mucus in your airways (mucus plug), which can occur after surgery, during severe asthma attacks or due to an infection
• Breathing in a foreign object, like food or small toy parts
• Fluid around your lungs
• Air around your lungs
• Cancerous tumors
• Noncancerous (benign) growths
• Lung scarring
• Underlying illnesses, including COPD, bronchiectasis, ARDS, COVID-19 and pneumonia

Complications

Without treatment, atelectasis complications may include:

• Low blood oxygen levels (hypoxemia)
• Pneumonia
• Respiratory failure

How doctors diagnose atelectasis

A healthcare provider will review your health history, perform a physical exam and order chest X-rays. They may recommend additional tests to help make an official diagnosis. These may include:

• CT scan to get more detailed pictures of your lungs
• Pulse oximetry to measure your blood oxygen levels
• Ultrasound to help see possible causes of atelectasis
• Bronchoscopy to look inside your lungs with a small camera

How is atelectasis treated?

Most cases of mild atelectasis go away without treatment. But you’ll need regular appointments with your provider so they can monitor you closely.

Depending on the cause and how much your lung collapses, your provider may recommend:

• Incentive spirometry to help expand and strengthen your lungs
• Bronchoscopy to remove a blockage in your lung
• Pulmonary toilet to help clear mucus
• Physical therapy to help your lungs expand
• Bronchodilators to open your airways
• Chemotherapy or radiation therapy to treat a tumor

Recovery time

Atelectasis after surgery usually goes away after 24 hours. Walking around, breathing exercises and using an incentive spirometer can help.

Other causes may take more time according to your treatment. Your healthcare provider will give you a better idea of what to expect.

When should I see my healthcare provider?

Reach out if you have breathing problems, especially after surgery or if you have an underlying condition. Even what might seem like minor symptoms may be signs that your lungs aren’t working the way they should.

What can I expect if I have atelectasis?

In most cases, with proper diagnosis and treatment, the outlook is good. It’s often reversible once healthcare providers determine the cause. Recovery is usually quick, and there aren’t any serious lasting effects.

If a long-lasting condition causes atelectasis, you may need further treatment. Your provider will tell you what to expect.