ATELECTASIS

From Big Medical Encyclopedia

ATELECTASIS (atelectasis; grech, ateles which are not made, incomplete + ektasis extension) — morbid condition of a lung or its any part, at Krom air cells do not contain air or support him in the reduced quantity and are represented fallen down.

And. it is necessary to distinguish from sites fiziol, hypoventilations in the lungs which sometimes are incorrectly called physiological And., practically always available for healthy people physical is able. rest. These sites represent fiziol, a reserve of breath for conditions of loading, but at pathology can become easier than others a basis for functional A.

Razlichayut's development inborn And.— not breathing easy or their parts at the newborn (And. in the true sense) and acquired And.— secondary fall of alveoluses in a lung, before breathing. Acquired And. sometimes call, especially in foreign literature, «collapse» of a lung; this term A. I. Strukov (1971) designates compression

A. A. polietiologichen and has various pathogenetic options with the general pathogenetic link — absence or restriction of intake of air in alveoluses.

Standard classification And. does not exist. The pathogenetic and anatomic principles of division are most often used.

Inborn atelectasis

Aetiology and pathogeny

Inborn And. it is more often observed at the following morbid conditions: 1) at mortinatus children is due to the lack of breath; 2) at aspiration by the newborn of amniotic waters or their impurity during asphyxia in labor (premature excitement of a respiratory center or filling of a mouth and respiratory tracts with waters to the first breath); 3) at premature newborn children owing to insufficient formation or lack of an anti-atelectatic factor — surfactant (see), cosecreted by an alveolar epithelium; 4) at malformations of bronchial tubes, an underdevelopment of respiratory departments of a lung and a hypoplasia of a pulmonary artery; such And. are designated as dizontogenetichesky; 5) at oppression of a respiratory center as a result of an injury or ischemia of the central nervous system at pathological childbirth. And., caused by the last reason, it is more correct to call anektazam because at the same time the delay of a raspravleniye of lungs is observed.

The pathological anatomy

At mortinatus is found total And., at which both lungs do not contain air, their volume is considerably reduced, tissue of a lung does not krepitirut, sinks in water. Typical localization partial And. newborns have I, II, IX and X segments in both lungs and the IV—V segments in the left lung that is explained by unequal degree of a differentiation of bronchopulmonary segments. Find aspirirovanny elements of amniotic waters, meconium, slime, blood in gleams of alveoluses and small bronchial tubes. On an inner surface of alveoluses hyaline membranes quite often are found (see. Hyaline and membrane disease of newborns).

X-ray inspection

On roentgenograms mortinatus is defined intensive homogeneous blackout of both pulmonary fields; on its background absolutely there is no image of heart and the pulmonary drawing. At newborns distinguish two main forms A.: massive and scattered. In the first case all lung (usually left) or the lung lobe is reduced in volume, does not contain air and causes an intensive homogeneous shadow in pictures. If And. it is connected with a neraspravleniye of pulmonary fabric and bronchial tubes are not filled with liquid contents, against the background of blackout light strips of the bronchial tubes filled with air come to light. At massive And. always there is a sharp movement of bodies of a mediastinum towards not finished lung. Intercostal spaces on the same party are narrowed, and the dome of a diaphragm costs above usual. As a rule, the hyper pneumatosis of an opposite lung, sometimes with formation of mediastinal hernias is noted. At a scattered form A. newborns in pictures roundish shadows of 0,1 in size — 0,3 cm caused by small multiple sites A are visible. For distinguishing them with the pneumonic centers it is necessary to consider anamnestic data, a clinical picture, a condition of the pulmonary drawing, shift of bodies of a mediastinum towards defeat, evolution of process.

The acquired atelectasis

the Aetiology and a pathogeny

the Acquired atelectasis pathogenetic is classified on three main options: obturatsionny (bronchial obstruction), compression (an external prelum of tissue of lung) and distenzionny, or functional (disturbance of conditions of stretching of a lung on a breath).

Along with the specified pathogenetic options of atelectases distinguish still And. reflex and so-called. And. allergic.

Obturatsionny atelectasis it is caused by full or almost full closing of a gleam of a bronchial tube at aspiration of foreign bodys (aspiration And.), at bronchial obstruction slime, a viscous phlegm, at endobronkhialno the growing tumor, at a prelum of a bronchial tube a tumor or cicatricial fabric from the outside. Extent of disturbance of ventilating and drainage function of a bronchial tube defines staging and rates of development And., and the caliber of the affected bronchial tube determines the size of the atelektazirovanny site (And. segments, segment, share, whole lung). At full bronchial obstruction rate of development And. it is caused by the speed of absorption of alveolar gases: full oxygen absorption comes from not ventilated site the first 30 min. after obstruction, carbon dioxide gas is absorbed in 2 hours, nitrogen — within 6 — 8 hour. In the site of fall of pulmonary fabric the congestive plethora develops, a cut is followed by transuding of edematous liquid in a gleam of alveoluses; activity of oxidation-reduction enzymes of an epithelium of bronchial tubes and alveoluses decreases, in a bronchial secret the maintenance of neutral increases and the amount of acid mucopolysaccharides decreases. Reduction of volume of a lung leads to increase of negative pressure in the same pleural cavity that promotes the shift of bodies of a mediastinum towards an atelectasis. The disturbances arising at the same time lympho-and blood circulations can cause a considerable fluid lungs («a flood of a lung»). The progressing destruction of mitochondrions of a bronchial and alveolar epithelium leads to further reduction of oxidation-reduction enzymes in the center And. The specified changes promote development of pneumonia on site And. and processes of a sklerozirovaniye. If obturation of bronchial tubes is liquidated later than in three days, the probability of a complete recovery of the site of the fallen-down lung considerably decreases.

Compression atelectasis (collapse) develops owing to an external prelum of pulmonary fabric at volume pathological processes in a chest cavity (aneurisms, tumors of a pleura or a mediastinum), at gidro-, a pneumohemothorax. Intrapleural pressure on the party compression And. does not decrease, and raises therefore in a zone A. there is no expressed delay of a lymph and a plethora as at obturatsionny A. Otsutstviye of endobronchial pathogenic factors promotes more favorable current compression And. in comparison with obturatsionny. At compression And. a complete recovery of functions of the fallen-down lung perhaps after removal even of a months-long compression.

Distenzionny (functional) atelectasis develops in the lower pulmonary segments owing to disturbances of mechanics of diaphragmal respiration or decrease of the activity of a respiratory center usually at the weakened bed patients more often. Quite often such And. come to light after an anesthesia and at a poisoning with barbiturates (owing to oppression of a respiratory center) and are observed also at the diseases which are followed by restriction of depth of a breath owing to increase in intra belly pressure (ascites, a meteorism) because of pains (a plastic pleuritis, peritonitis, etc.) or owing to a phrenoplegia. Small respiratory mobility of a diaphragm is a proximate cause of a hypopneumatosis of the lower segments of a lung in all these cases that breaks respiratory stretching of separate segments. A certain role in emergence functional (in particular, discal) And. play the reflex reductions of muscular elements in a lung caused by cardiopulmonary, abdomino-pulmonic and other visceral reflexes on pulmonary segments.

Besides, can develop in circles of pneumonic focuses, abscesses of a lung, tubercular cavities parapneumonic atelectases, in which emergence local obturation of bronchial tubes in combination with a compression inflammatory exudate has the leading value. It is especially promoted by bystry increase in the sizes of a cavity, e.g., at tubercular cavities with a valve mechanism of their ventilation.

Allocation reflex atelectasis it is based that in development And., received on a pilot model by irritation of a pleura or bronchial tubes, the leading role of active reduction of muscular elements of a lung was shown. However designation A., arising after the heavy injuring operations as reflex it is not always justified since its origin is usually caused by a combination of above-mentioned mechanisms to the leading value of one of them, is more often than obturatsionny. At the same time during surgical interventions cases total or subtotal are sometimes observed

And. both lungs at full passability of a bronchial tree. Data of a morphological research in these cases can confirm only a reflex origin And. Indirect demonstration of the reflex nature of similar And. also instant fall of a parenchyma of lungs after the termination of hardware breath is.

The atelectasis can arise at allergic diseases and is connected with a spasm of bronchial tubes and hypostasis of a mucous membrane. It is characterized by sudden emergence and rather bystry disappearance that in general is peculiar to allergic processes. At differential diagnosis of atelectases of various etiology it is necessary to remember a possibility of an atelectasis of an allergic origin that gives the chance timely to apply antiallergenic therapy.

Pathological anatomy

signs of fall of pulmonary fabric, and also an inflammation with disturbance of blood circulation in airless sites Are noted. Macroscopically tissue of lungs in a zone A. gets a fleshy consistence, at palpation does not krepitirut, sinks in water. At total bilateral And. lung volume is considerably reduced, at focal And. the fallen-down sites are easily distinguishable against the background of air pulmonary fabric; small peripheral And. have an appearance of several sinking-down infarktopodobny centers of red color. During the first hours development And. in its zone the plethora of vessels of all calibers, in a gleam of alveoluses — edematous liquid, bronchioles quite often spazmirovana is noted.

At an obturatsionny atelectasis in the next 2 — 3 days signs of an inflammation come to light. Gleams of alveoluses are filled by macrophages, neutrophils, with shelled cells of an alveolar epithelium, in gleams of bronchial tubes — slime with impurity of a desquamated epithelium and leukocytes. Desquamation of a bronchial epithelium leads to «baldness» of bronchial tubes. In the subsequent 7 — 14 days alterativno-proliferative changes can progress as atelectatic pneumonia. In the outcome And. the pneumosclerosis, bronchiectasias develops, it is frequent in the form of retentsionny cysts of bronchial tubes. In 8 — 12 months the atelektazirovanny share is condensed to 1/8 — 1/10 initial sizes. However the outcome in pneumocirrhosis, apparently, is not the rule. A. I. Strukov,

V. D. Firsov proved a possibility of reaeration of the center And. in many months after its formation, A. I. Klembovsky finds possible collateral intersegmental movement of air on alveolar fabric bypassing the corked bronchial tubes and bronchioles. Evolution And. it can be limited to a perivascular sclerosis and reorganization of vascular system — a thickening of a subintimalny layer of intra lobular veins, a sclerosis of large arterial trunks, reorganization of small branches of a pulmonary artery as the closing arteries.

Pathoanatomical changes of lungs at a compression atelectasis essentially do not differ from described above, especially in a stage of atelectatic pneumonia, but rates of its development are slower and the initial plethora as at obturatsionny A.

Distenzionnye atelectases are localized more often in back and basal segments of lungs is not noted, differ in incomplete fall of sites of a lung and a mosaic pathomorphologic picture. Frustration krovo-and lymphokineses at them are expressed a little up to a phase of a complication by the pneumonia proceeding usually as an alveolitis.

T. M. Darbinyan and V. N. Shlyapnikov believe that topography And., arising after traumatic operations, is defined, apparently, by reflex mechanisms. At a gall bladder, pancreas and stomach operations And. it is observed more often in the IX—X segments, at brain operations — in segments of upper shares and in IV, V, VI segments of both lungs. Histologically find the spasm of bronchioles indicating the contraction nature And.

The clinical picture

the Clinical picture is heterogeneous, division is defined by the main pathogenetic mechanism, localization, the size and rate of development of A. Tselesoobrazno And. on a current on acute and developing gradually.

The Obturatsionny atelectasis of a share or all lung at its acute development causes a paroxysmal asthma, tachycardia, cyanosis. At gradual development these symptoms are expressed less. On the party obturatsionny And. the thorax sinks down a little, lags behind in the act of breath; resistance of intercostal spaces increases. The lower bound of a lung on the party And. perkutorno is defined above, than on the healthy party; the respiratory excursion of the lower bound is reduced; a percussion sound over a zone A. it is shortened or stupid. Percussion of bodies of a mediastinum reveals their shift aside And., especially noticeable at massive right-hand And., when the cardiac impulse can be displaced from a breast to the right. At auscultation over area A. sharp weakening of vesicular breath is noted or breath is not listened at all.

Over obturatsionny And. an upper lung lobe the weakened wire tracheal respiration can be listened. Even at a complication And. pneumonia the appearing rigid or bronchial breath remains sharply weakened; sometimes respiratory noise are not listened, but on the maximum breath or an exhalation it is possible to listen to dry or wet rattles. The percussion dullness and weakening of breath caused And., are quite often mistakenly regarded as signs of existence of a pleural exudate. Especially often such mistake is made at And. the lower share on the right, when percussion dullness over And. merges with dullness of a liver. At differential diagnosis it must be kept in mind that at And. percussion dullness most highly is defined at a backbone (but not in the area of Damuazo as at pleurisy) and the mediastinum is displaced towards percussion dullness.

At total or subtotal And., developing in the first days after traumatic surgeries (is more often on the right lung), signs acute massive obturatsionny come to light And. and symptoms of pneumonia: fever, puffiness and cyanosis of the person, tachycardia, tachypnea, cough. Quite often over a zone of percussion dullness bronchial breath, crepitation is listened at, listening of the patient in a sitting position and after expectoration, later — wet rattles. Existence at the described symptom complex of a leukocytosis and the accelerated ROE usually conducts to the wrong diagnosis of pneumonia. From usual pneumonia And. clinically differs only in the shift of a mediastinum in the patient, the party, a cut comes to light perkutorno and by means of X-ray inspection.

Compression atelectasis. Complaints of the patient and clinical manifestations are caused by a basic disease. At a research find lag of a sick half of a thorax at breath; retraction of a thorax and narrowing of intercostal spaces is not observed. The percussion sound dulled and a zone of obtusion is defined not only, and sometimes and not so much And., how many basic process, it caused (a pleural exudate, a tumor etc.). Bodies of a mediastinum are displaced towards a healthy lung since at compression And. on the party of defeat intrapleural pressure is increased. At auscultation bronchial breath is defined, there are no rattles. Subcrepitant rattles are listened in sites incomplete compression And. or in an initial stage of its raspravleniye. The last needs to be considered at differentiation of Ampere-second pneumonia.

Distenzionny atelectasis more often happens the small sizes, does not affect function of breath and it is seldom distinguished, but at the considerable size or plurality of the centers And. there are clinical signs sufficient for diagnosis. Patients can complain of an asthma. Breath is usually superficial, the lower bound of lungs — is one-two edges higher than norm. On perimeter of a thorax at the level of the lower bound of lungs the weakened vesicular breath is listened; at a deep breath the bitter rattles connected with a raspravleniye of the fallen-down pulmonary fabric come to light. They often disappear after several deep breaths, unlike the rattles at focal pneumonia which are not changing from a postural change of the patient and after deep breath. Distenzionny A. is not followed by temperature reaction, a leukocytosis and acceleration of ROE, it is more often distinguished radiological (in the form of discal And.), than clinically.

See also Bronchiectasias , Lungs , Pneumonia , Tuberculosis .

Radiodiagnosis it is carried out by means of roentgenoscopy and a X-ray analysis of lungs in two projections, and in more hard cases — on the basis of data of a tomography. X-ray pattern And. it is characterized by four groups of symptoms: a) structural change and density of a shadow of a lung in a zone A. and beyond its limits; b) change of situation, form and the sizes of the fallen-down departments with simultaneous expansion and movement of the next departments of a lung; c) movement of bodies of a mediastinum, roots of lungs, diaphragms, subphrenic bodies; d) a functional symptom of a bronchostenosis (see the Bronchostenosis, Goltsknekhta-Jacobson a symptom).

Fig. 1. Atelectasis of an upper share right «lung. Massive blackout on the right (roentgenogram).

In most cases at And. uniform blackout of the relevant departments of the pulmonary field (fig. 1), shift of bodies of a mediastinum and root of a lung towards defeat, a high arrangement of a dome of a diaphragm and subphrenic bodies on the party is observed And., inflation of not changed departments of a lung, and sometimes — an opposite lung.

Fig. 2. An atelectasis of an upper share of the left lung with the shift of a mediastinum to the left at the central cancer of the left lung (the roentgenogram: and — a direct projection; — a side projection; blackout in the field of an atelectasis is expressed).

At the maximum fall of some share almost all thoracic cavity on the party And. it can be filled only with expanded next shares. Small reduction of the fallen-down part of a lung can be compensated by expansion of its next departments without changes of topography of bodies of a thorax. On Van-Allen (Van Allen), for And. total homogeneity of a shadow, a so-called symptom of ground glass which, however, not patognomonichen for is characteristic And., since it is observed also at cirrhosis of a lung, sometimes — at a massive acute pneumonia; regarding cases a shadow And. it is represented not homogeneous because of imposing of the image of surrounding pulmonary fabric. Intensity of a shadow And. it is usually big, in particular at its big sizes, at a considerable hyperemia and puffiness of the fallen-down pulmonary fabric. Intensity of blackout depends not only on density And., but also from degree of swelling (enlightenment) of the next departments of a lung. At considerable expansion of the last shadow And. owing to the known patterns of summation of shadows causes only a picture of decrease in transparency of the pulmonary field. True character of blackout can in these conditions be established only at a research of a thorax in side situation (fig. 2). It is above and blackouts the pulmonary field is given in various degree by brightened up below, is more considerable in a direct circle And. According to the stretched departments of a lung the pulmonary drawing is impoverished: intervals between shadows of vascular trunks increase, the number of small vascular shadows decreases.

Fig. 3. A X-ray pattern of total and share atelectases of both lungs (on the scheme are represented in black color): 1 — an atelectasis of all right lung; 2 — an atelectasis of all left lung; 3 — 12 — an atelectasis of separate shares of the right and left lungs. Right lung: atelectasis of an upper share (3 and 4); atelectasis of an average share (5 and b); an atelectasis of the lower share at small (7) and considerable (8) its fall. Left lung: an atelectasis of an upper share at small (9) and considerable (10) its fall; an atelectasis of the lower share at small (11) and considerable (12) its fall, (and — a direct projection — a side projection.)

At a total atelectasis (fig. 3,1 and 2) the fallen-down lung is usually reduced, intensively and evenly darkened. In most cases shadows of edges are pulled together (according to retraction of a chest wall), is sometimes observed chop off -

oz chest department of a backbone, camber turned towards defeat. A dome of a diaphragm and a shadow of subphrenic bodies on the party And. are raised; at the left the gas gastric bubble is unusually highly and medially projected. The median shadow, in particular a trachea, is considerably drawn aside And., bifurcation of a trachea is projected sideways from a shadow of a backbone. Not affected second lung is blown up, and its shadow is partially moved to an opposite half of a thorax. Such movement is experienced by hl. obr. anterosuperior pozadigrudinny departments of an opposite lung, giving in radiological display a picture of so-called mediastinal hernia, i.e. the enlightenment limited to the arc-shaped line against the background of upper medial departments of the darkened pulmonary field on the party And. Such «hernias» can reach the big sizes, in particular at And. left lung.

The X-ray pattern at share atelectases is typical (fig. 3, 3—12). It is known that shares of lungs are as if fixed in two places: at a root and because of negative intrapleural pressure at a chest wall. Owing to these features fall and movement of shares of lungs at And. occurs in case of lack of pleural unions naturally in a certain direction. The upper share of the right lung is displaced at And. up, knutr and kpered in the direction of anteromedial departments of a thorax. The lower bound of a shadow of the fallen-down share (the line of a small interlobar crack) moves up, back (the line of the main interlobar crack) — kpered. On the side roentgenogram the triangular shadow decides on a little involved smooth contours, the top a cut adjoins a shadow of a root, and the basis — a chest wall. Against the background of this shadow the line of a slanting interlobar crack, the moved kpereda is well visible. At the accruing fall of a share the last approaches a chest wall and disappears. Fall of an upper share can be so considerable that on the direct roentgenogram its shadow is represented a narrow side strip at a mediastinum, and in a side projection — simulates consolidation of a pulmonary segment. And. an upper share is followed by expansion the lower and average share, posterosuperior departments lower and upper front departments of an average share are exposed to the greatest swelling. The shadow of a root of a lung moves, as a rule, up. At And. the right upper share, as well as at And. other shares, also the atypical pictures which are quite often simulating a picture of mediastinal «hernia» on the front roentgenogram that is caused by hl are observed. obr. the pleural unions fixing a lung. X-ray pattern And. an upper share of the left lung differs in the large volume, more steep arrangement of the left slanting interlobar crack and not always the clear lower bound of a shadow: regarding cases it is dugoobrazno involved.

An average share at And. it is displaced knutr and kpered. Its upper bound moves from top to bottom, lower, corresponding to a slanting interlobar crack — up and several kpereda. On the direct roentgenogram the fallen-down share is projected in lower medial departments of the pulmonary field; the shadow of its usually triangular shape, has the contours or the involved or rectilinear lower and slightly convex upper contour bent top and bottom. In a side projection the shadow has also the form of a triangle with equal and more often the involved contours or a form of a strip, an oval, a semi-oval with the convex upper and rectilinear or involved lower bound. At sharp reduction of an average share it can be presented on the direct roentgenogram by uncharacteristic low-intensive blackout, and only the research in side or lordotic situation allows to reveal the shadow characteristic for And. average share. The shadow of a root moves usually from top to bottom.

The lower shares of both lungs are displaced at And. from top to bottom, knutr and kzad. On the direct roentgenogram the reduced share has the form of the triangular shadow turned by top to a root and the basis to a diaphragm. The outside border of a shadow is a little involved, sometimes — convex or rectilinear. At big reduction of a share the triangular shadow at a contour of a backbone is defined the small sizes, edges it can be blocked by a shadow of heart at the left. In a side projection the shadow of the fallen-down share partially accumulates on a shadow of a backbone; the line of the moved kzada of a slanting interlobar crack is visible. Fall of the lower share is followed by swelling upper, and on the right — and an average share; the shadow of a root is displaced from top to bottom and knutr.

Fig. 4. A X-ray pattern of segmented atelectases (on the scheme are represented in black color): 1 — an apical segment; 2 — a back segment; 1 + 2 — apical-back at the left; 3 — front; 4 — outside on the right, upper lingular at the left; 5 — internal on the right, lower lingular at the left; — upper the lower share; 7 — lower internal; 8 — lower front; 9 — lower outside; 10 — lower back. (and — a direct projection — a side projection.)

The segmented atelectasis has less characteristic X-ray pattern, a shadow it quite often simulates a picture of segmented consolidation of the inflammatory nature. Secondary symptoms are usually not expressed. As a rule, segmented And. does not cause retraction of a chest wall and changes of an opposite lung. Usually fall of a segment is followed by movement only of the pieces of interlobar cracks adjoining on it, inflation of the next departments of a lung. Goltsknekht's symptom — Jacobson at segmented And. it is expressed insufficiently clearly. Sometimes the diagnosis can be established only by means of a tomography or a bronchography. X-ray pattern And. separate segments of a lung it is presented on the scheme (fig. 4).

Lobular and acinous atelectases usually happen multiple. Radiological they are not otlichima from shadows of focal pneumonia, about a cut are quite often combined. At a large number lobular And., occupying the most part of a lung, secondary symptoms are observed And., in particular a positive symptom of Goltsknekht — Jacobson.

Fig. 5. A discal atelectasis of the right lung (the strip of blackout is designated in black color).

Discal, or lamellar, atelectases, are located usually low over a diaphragm; radiological have the form of cross located polosovidny shadows (fig. 5) from 0,5 to 1,5 cm wide which are quite often represented a little rastruboobrazno expanded knaruzh or kpered. Shadows discal And. do not correspond to the course of interlobar cracks that allows to distinguish them from tape-like shadows of interlobar pleurisy. Discal And. meet in the right lung more often, sometimes happen multiple, quite often quickly (sometimes at forced ventilation) disappear. At long

existence diskrvidny And. the respective site of a lung can undergo cicatricial transformation.

At X-ray inspection And. it is necessary to differentiate with sequestration of a lung, the filled cysts of lungs, a tumor of a lung and a mediastinum, phrenic hernia and pleurisy.

But the task of the radiologist is not limited to A. S's identification by the help of roentgenograms, tomograms, elektrokimogramm and especially complex bronkhologichesky research it shall promote establishment of the reason And. willows the first stage to differential diagnosis of such diseases, as a tumor, a bronchial tube, a tubercular bronchostenosis, damage of a bronchial tube on the soil hron, inflammations, and also a foreign body of a bronchial tube.

Forecast

Massive And. one or both lungs, developing after heavy surgeries, come to an end, as a rule, with death on the operating table or in the next postoperative period. At And. other nature the forecast concerning life and recovery substantially is defined And., but the basic disease which caused its development. Have the optimum forecast distenzionny and compression And. at a hydrothorax; elimination of the reasons which caused emergence of these And., leads to a complete recovery of structure and function of a lung. Obturatsionny A. often is complicated by pneumonia; its forecast is especially adverse at obturation of a bronchial tube a cancer tumor. Also localization of defeat matters. So, in connection with features of a midlobar bronchial tube — long, narrow, departing almost at right angle and surrounded with group limf, nodes — reaeration And. an average share it is more complicated, than And. other localization. Quite often And. an average share early is complicated by the infectious inflammation accepting hron, a current with formation of bronchiectasias and development of fibrosis in pulmonary fabric («a syndrome of an average share»).

Treatment

Treatment shall be directed to recovery of aeration of not ventilated sites of a lung that is reached by causal or pathogenetic therapy. Causal therapy is defined by a basic disease (surgical, beam or conservative treatment of a tumor of a bronchial tube, antibacterial therapy of pneumonia, removal of a foreign body from a gleam of a bronchial tube). Pathogenetic therapy obturatsionny And. at pneumonia consists at a distance of bronchial tubes of products of an inflammation (slime, pus, blood, etc.) via the bronchoscope (see. Bronkhoskopiya ), a bronchial lavage solution of antiseptic agents, antibiotics, instillations of the bronchial spasmolytics and means promoting an otkhozhdeniye of a phlegm. The drainage is used by situation (active cough of the patient in situation on a healthy side). Compression And. at pleural exudates is eliminated with a timely pleurocentesis or purpose of the means reducing an exudate. At distenzionny And. the respiratory gymnastics, inhalation of 5% of mix of carbon dioxide gas with air (or oxygen), respiratory analeptics is appointed (Cordiaminum, camphor, caffeine, etc.).

Prevention

For prevention distenzionny And. at bed patients early use of physiotherapy exercises, elimination of the factors limiting diaphragmal respiration is necessary (elimination of a meteorism use of a diet, purpose of cleansing enemas and purgatives at a delay of a chair; purpose of analgetics at the pains connected with breath).

An atelectasis at children

Fig. 6. An inborn atelectasis of the lower share of the right lung at the child of 13 years. On the right over a diaphragm the massive wedge-shaped site of blackout (roentgenogram).

The atelectasis at children is most often localized in the lower and average shares of right easy (fig. 6), however can develop also in other departments, in particular in upper shares of both lungs, especially at pneumonia and bronchial asthma. The comparative narrowness of a tracheobronchial tree and tendency to giperergichesky reactions from a mucous membrane of a trachea and bronchial tubes at children create favorable conditions for development And.

Fig. 7. An atelectasis of an upper share of the left lung at the child of 5 years after removal of the lower share (roentgenogram).

To emergence And. at children conducts hit of foreign bodys in a tracheobronchial tree, various forms of an acute pneumonia, a bronchospasm at bronchial asthma. And. a lung at children can gradually develop. Medical tactics at And. at children shall be especially active since morphological changes in atelektazirovanny departments of a lung at the child develop quicker, than at adults. And. the operated lung is a frequent complication of operation on lungs at children (fig. 7). For the purpose of prevention postoperative And. the following events are held: training of the child in the correct breath before operation, full sanitation of a tracheobronchial tree to and during operation, laying of the child on a healthy side, use of effective anesthesia, a complex of medical exercises, and in need of a microtracheostomy (see. Tracheostomy ) and the device «artificial cough» in the postoperative period. The good raspravleniye of a lung is promoted by suction by means of a catheter of contents from bronchial tubes in the first days after operation. In the absence of effect the medical bronkhoskopiya is shown.


Bibliography: Akims D. V. Rol of an atelectasis in a pathogeny and clinic of acute pneumonias, Klin, medical, t. 16, No. 2, page 216, 1938; Vail S. S. About an origin and morphology of some early changes of lungs in the postoperative period, Eksperim. hir., No. 4, page 3, 1959; D and r-binyan T. M., etc. Postoperative atelectases of lungs at patients with inborn heart diseases, Grudn. hir., No. 6, page 26, 1963, bibliogr.; To l e m about Sunday to and y A. I. Bronchial segments of lungs, their reflection in pathology, in book: Vopr. patol, and regenerations of bodies of blood circulation and breath, under the editorship of E. N. Me-shalkin and I. K. Yesipova, century 1, page 325, Novosibirsk, 1961, bibliogr.; Mavrin V. K. An experimental atelectasis according to a histologic and histochemical research, Arkh. patol., t. 25, No. 9, page 69, 1963, bibliogr.; Also the N is mute at-shch and I am L. I. Changes of elastic tissue of lung at an experimental share atelectasis, in the same place, t. 24, No. 6, page 29, 1962; it, Morphological changes in lungs at a share atelectasis, in the same place, t. 26, No. 6, page 34, 1964, bibliogr.; Nesterov E. The N» Surfactant of lungs and its role is normal also of pathology, in the same place, of t. 29, No. 7, page 3, 1967, bibliogr.; Savinich B. V. About changes in a lung at the obturation of a bronchial tube which is combined with pheumothorax, Probl. tube., No. 3, page 86, 1957; Sarkisov D. S., etc. Postoperative pulmonary complications, M., 1969, bibliogr.; Strukov A. I. Morphology of a kollabirovanny lung, Doctor, business, No. 7-8, page 297, 1945; F and r with about in V. D. and Kryuchkov G. S. Morphological changes in a lung at a long atelectasis and a possibility of their involution, Klin, hir., No. 4, page 43, 1968; The Guide to pulmonary surgery, under the editorship of. And. S. Kolesnikova, L., 1969; T. N.'s Capers Pulmonary hyaline membrane formation in the adult, Amer. J. Med., v. 31, p.701, 1961; ChestermanJ.T. Recurrence after resection for bronchiectasis, Brit. J. Surg., v. 45, p. 155, 1957; Kuhn C. o. Pulmonary alveolar proteinosis, Lab. Invest., v. 15, p. 492, 1966, bibliogr.; Modell J. H., Heinitsh H. G i-ammona S. T. The effects of wetting and antifoaming agents on pulmonary surfactant, Anesthesiology, v. 30, p. 164, 1969; Moersch H. J. Bronchoscopy in treatment of postoperative atelectasis, Surg. Gynec. Obstet., v. 77, p. 435, 1943; P a t t 1 e R. E. Properties, function and origin of the alveolar lining layer, Nature (Lond.), v. 175, p. 1125, 1955; Stern H.f Bond W. F. a. L an i o s N. C. Pulmonary alveolar proteinosis, Dis. Chest., v. 39, p. 82, 1961.

Radiodiagnosis of A.— Lindenbraten L. D. and Naumov L. B. Radiological syndromes and diagnosis of pulmonary diseases, M., 1972; P about-meltsov K. V. Radiological diagnosis of a pulmonary tuberculosis, M., 1971, bibliogr.; Rokhlin D. G. Pulmonary segments in the x-ray image are normal also of pathology, L., 1966, bibliogr.

And. allergic — Krayp L. Clinical immunology and an allergy, the lane with English, M., 1966, bibliogr.; Lerner I. P. Eosinophilic pulmonary infiltrates of a noninfectious origin, Doctor, business, No. 4, page 24, 1966; M.E. Avery. Said S. Surface phenomena in lungs in health and disease, Medicine (Baltimore), v. 44, p. 503, 1965; Saner-k i n N. G. Causes and consequences of airways obstruction in bronchial asthma, Ann. Allergy, v. 28, p. 528, 1970, bibliogr.; Tierney D. F. Pulmonary surfactant in health and disease, Dis. Chest, v. 47, p. 247, 1965.

And. at children — Veller D. G. Treatment of postoperative atelectases of a lung «washing of a trachea», Vestn. hir., t. 91, No. 12, page 84, 1963; Vladykina M. I. Radiodiagnosis of atelectases of lungs at children, L., 1971, bibliogr.; Dergachev I. S. Pneumonia of newborns and children of chest and early age, Mnogotomn. the management on a stalemate. annate., under the editorship of A. I. Strukov, t. 3, page 574, M., 1960, bibliogr.; Yesipova I. K. and Kauffman O. Ya. Post-natal reorganization of a small circle of blood circulation and atelectasis of newborns, L., 1968, bibliogr.; And with and to about in Yu. F., etc. Dependence of frequency postoperative an atelectasis from a type of a resection of lungs at a bronchietasia at children, Grudn. hir., No. 6, page 67, 1970; Klimkovich I. G. and Table-tser E. E. Atelectases after lung operations at children, in the same place, No. 4, page 61, 1963; Kodolova I. M. and Friedman E. E. Borders of segments of lungs and lamellar atelectases at children, Arkh. patol., t. 30, No. 8, page 37, 1968, bibliogr.; The Chernyakhovsk F. R. Apparat of artificial cough of IK-1 in prevention and treatment of postoperative atelectases of lungs, Is new. medical tekhn., century 3, page 91, 1965.

N. K. Permyakov; V. P. Zhmurkin, I. P. Zamotayev (rubbed.), I. P. Lerner (ave), L. D. Lindenbraten (rents.), JI. M. Roshal (ped.).

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