Our lungs are one of the hardest working organs in the body. Each minute, our lungs expand and contract up to 20 times. This is done to exchange carbon dioxide with oxygen. An obstruction in this process is called as bibasilar atelectasis, which is a life-threatening condition. It mostly happens post-surgery in patients who have breathing problems, trauma caused to the lungs, and obese patients.
What is bibasilar atelectasis?
Bibasilar atelectasis refers to a partial or complete lung collapse. It can affect either one or both lungs. Our body has two lungs--one on the right and the other on the left. Both lungs contain lobes. The right lung has three lobes whereas the one on the left has two lobes. Throughout the lungs, there are tiny air sacs in a shape of a balloon, which contain blood vessels. These blood vessels are arranged in a cluster and are called as alveoli. The alveoli can abnormally deflate due to an airway obstruction. This problem has an impact on the bottom portion of the lungs, which can be life-threatening due to the lack of oxygen. In such condition, the oxygen is unable to reach other vital organs of the body.
Bibasilar atelectasis is quite similar to pneumothorax, but may have different causes since there are various conditions that can lead to this medical issue. Moreover, pneumothorax is one of the causes of bibasilar atelectasis.
There are various ways that can lead to an obstruction in the airflow happening within the lungs. This medical condition is often seen after surgery or as a result of complication due to prior respiratory health conditions, which can be severe asthma, cystic fibrosis, or a force that leads to trauma in the lungs. Below are some of the causes of bibasilar atelectasis:
- Foreign Object: When an individual tends to inhale a foreign object or body, then it can lead to a collapse of the lung either partial or complete. Such cases can mostly happen in small children, who unintentionally inhale small particles such as peanuts or a small part of any toy. Hence, adult supervision is a must when children are eating or playing to prevent such happening.
- Mucus Plug: While surgery, the lungs respond to medications by causing a decrease in the rate of inflation. This then allows the mucus to accumulate in the airway. However, doctors will use the suction method to remove the mucus, but there would be still some present afterward. Mucus plugs have mostly occurred in individuals who suffer from asthma and cystic fibrosis. Deep breathing exercises are carried out during recovery to expel out the mucus from the airways.
- Anesthesia: The administration of general anesthesia when performing surgical procedures is known to be one of the common causes of bibasilar atelectasis. The use of anesthesia is done to prevent feeling any kind of pain sensations during surgery. It also controls a patient's flow of blood, heart rate, and blood pressure level. However, anesthesia is also known to control the breathing technique of the lungs. When a person has been given anesthesia, his breathing ability reduces, which can lead to bibasilar atelectasis.
- Lung Damage: Any kind of damage to the lungs can easily lead to bibasilar atelectasis or lung collapse. The air can easily escape from the lung opening into the space between the lung and chest wall. This can be due to pneumonia or COPD.
- Trauma to the Lungs: Lung injuries can be due to physical assault or stabbing in the chest with a sharp knife or any other instruments that can lead to lung compression. An accident or a gunshot wound are also other reasons that can lead to lung trauma.
- Clotting of the Blood: Blood clotting is also known to be one of the causes of bibasilar atelectasis. In such cases, the blood escapes from the bloodstream and enters the inside portion of the lungs. This is very common when one has gone through a blunt force or trauma on the chest.
- Narrowing of the Airway: There are certain kinds of lung infections caused by bacteria, viruses or fungi that can lead to the narrowing of the airways. This is due to the scarring, which occurs because of these lung infections.
- Tumor: There can be a presence of a large tumor that could press against the lungs and deflate the lungs as opposed to blocking the airway.
Bibasilar atelectasis mainly affects the bottom portion of the lungs and is usually asymptomatic. However, in certain cases, it tends to affect a greater portion of the lung or the entire lung, which can lead to life-threatening issues. In such cases, the individual would experience certain symptoms that would need to be quickly addressed. Below are some of its symptoms:
- Sudden fever
- Anxiety attack
- Excessive coughing
- Coughing up sputum
- Skin discoloration
- Severe pain mostly in the chest region
- Irregular or fast heartbeat
- Difficulty in breathing
- Decrease in chest expansion
When to Visit the Doctor
Since bibasilar atelectasis usually happens post-surgery, most patients are already hospitalized. However, seek medical attention immediately if you experience breathing troubles. There are other medical conditions that can also lead to a difficulty in breathing. Hence, an accurate diagnosis would be needed before starting off with the treatment. If the breathing becomes increasingly difficult, then it is considered as an emergency case. However, such instances are quite a rare occurrence.
Questions to Ask the Doctor
- What are the reasons behind the symptoms of the condition?
- What kind of tests are needed to be carried out to diagnose the condition?
- If I have an another existing medical condition, how can they both be managed together?
- What is the course of action recommended for this condition?
- Are there health restrictions to avoid the condition from worsening?
There can be cases when the doctor can confuse bibasilar atelectasis with pneumothorax. Thus, there is a need for a proper diagnosis and specific tests to carry out to differentiate the two conditions. Aside from physical examination, the doctor can request for a complete blood count (CBC), electrolyte tests, and kidney function tests.
- Chest X-ray: A chest X-ray is needed for the diagnosis of bibasilar atelectasis. In this imaging test, doctors can identify the presence of foreign bodies in the airways, if there are any. It is also one of the most common causes of obstruction in children and adults.
- CT Scan: When compared to a chest X-ray, a CT scan is more sensitive in detecting the causes of bibasilar atelectasis. It can measure the lung volumes in parts or the entire lung. This scan can also help determine the presence of a tumor, which could have caused the lung to collapse. Such findings can be something that does not usually show up on a regular chest X-Ray.
- Bronchoscopy: The process of bronchoscopy is carried out by using a flexible and lighted tube, which is threaded down the throat. This would enable the doctor to view, and if possible, at least partially remove any kind of obstruction in the airways. Some obstructions can be a mucus plug, a foreign body that can be easily removed, or a tumor.
- Pulse Oximetry: It is a very simple test used to measure the level of oxygen in the blood. This test involves the use of a small device, which is placed on the fingers to measure the oxygen saturation in the blood.
The treatment of bibasilar atelectasis largely depends on the underlying cause. If the condition is mild, then it could subside without the need for any treatment. However, if there are any major underlying causes such as tumors, then they would need to be treated with the help of radiation or chemotherapy. Surgery can also be performed to remove the growth. There are certain techniques applied to help the patients breathe deeply after surgery. This breathing technique would help the patient in re-expanding the collapsed lung tissues. One can learn such techniques prior to the surgery.
A few of the techniques include deep coughing and clapping on the chest wall to loosen the mucus present in the area. You can also get the mucus mechanically cleared with the help of an air-pulse vibrating vest. Incentive spirometry along with deep breathing techniques can help manage the condition in a better way.
Postural drainage can also be done wherein the body is positioned in such a way that the head is held lower than the chest region. This would allow the mucus present in the chest to drain from the bottom of the lungs. Another technique is using bronchodilators for opening up the bronchial tubes and make breathing easier for affected individuals. The doctor can also prescribe mucus thinners such as acetylcysteine to help thin the mucus, thereby making it easier to expel phlegm out of the body.
In children with cystic fibrosis, certain medications can be given such as dornase alfa, which can be used to clear up mucus plugs. The doctor can also use a bronchoscopy technique to get rid of the mucus and clear the airways. For those who have shortness of breath, they can be given supplemental oxygen to provide relief. In
In severe bibasilar atelectasis cases, the doctor can recommend a surgical procedure to remove the obstruction in the airways. When bibasilar atelectasis is an acute case, the doctor can suggest procedures such as coughing, suctioning, and bronchoscopy. Chronic cases may require a surgical intervention to remove the affected part of the lung. After the surgery, the patient would be given antibiotics to treat infections. Using a continuous positive airway pressure (CPAP) can be really helpful for certain people who are weak to cough and those who have low levels of oxygen post-surgery.
The following factors tend to increase the risk of developing bibasilar atelectasis:
- Anyone younger than 3 years old or anyone older than 60 years old.
- Conditions that cause an interference in spontaneous coughing, yawning, or sighing.
- A difficulty in swallowing, which is mostly seen in elderly people.
- Individuals who have any kind of lung diseases such as asthma, COPD, cystic fibrosis, or bronchiectasis.
- Premature delivery of a baby.
- Any recent surgery of the chest or abdomen.
- Recent use of general anesthesia.
- Shallow breathing due to the associated side effects of medications, rib fracture, or pain in the abdomen.
If bibasilar atelectasis is not treated in a timely manner, it can lead to certain complications such as:
- Pneumonia: An individual is at a greater risk of developing pneumonia unless bibasilar atelectasis has been completely cleared. The mucus present in the collapsed lung can lead to various kinds of infection and can affect other parts of the body.
- Hypoxemia: This term means a lack of oxygen in the body. Bibasilar atelectasis tends to hamper the lung’s ability to get the oxygen to the alveoli.
- Respiratory Failure: A small portion of a collapsed adult lung can be treated. However, if an entire lung is affected or has collapsed, then it can lead to life-threatening issues. This can especially happen in cases of infants suffering from any kind of lung disease.
When it comes to small children, keep a watch on their surrounding so that they do not mistakenly inhale anything. When it comes to adults, this condition can happen post-surgery. Thus, one should talk with the doctor about the ways to minimize the risk of developing this condition before undergoing the surgical procedure.