Can subsegmental atelectasis cause pain?

Can Subsegmental Atelectasis Cause Pain?

Yes, subsegmental atelectasis can cause chest pain, particularly when it occurs in association with inflammation or pleural involvement. 1

Pathophysiology of Pain in Atelectasis

• Chest pain is a documented symptom in patients with atelectasis, particularly when the atelectasis is associated with inflammation or involves the pleura 1
• Pain may co-localize with the position of the atelectasis as seen on CT scans, suggesting a direct relationship between the collapsed lung tissue and pain sensation 1
• The pain from atelectasis is typically not musculoskeletal in nature (not related to coughing) and is not associated with chest wall tenderness 1
• Atelectasis can generate inflammation and structural alveolar injury in the surrounding lung tissue, which may contribute to pain sensation 2

Clinical Presentation of Pain in Atelectasis

• Pain associated with atelectasis often occurs early in the course of the condition and may persist until recovery 1
• In a study at Monash Medical Centre, 44 out of 178 patients with bronchiectasis reported chest pain, with 39 of these cases having pain associated with exacerbations 1
• Imaging studies during exacerbations associated with chest pain showed abnormalities such as consolidation, collapse, or atelectasis in 18 out of 33 patients 1
• Only a small proportion of patients (4 out of 44) experienced clear pleuritic pain, while most had other types of pain 1

Mechanisms of Pain in Atelectasis

• When alveoli collapse, traction forces exerted on their walls by adjacent expanded units may increase and concentrate, potentially causing pain 2
• These forces may promote re-expansion at the expense of potentially injurious stresses at the interface between collapsed and expanded units 2
• Experimental models have shown that non-lobar atelectasis can act as a stress concentrator, contributing to inflammation in the surrounding healthy lung tissue 2
• Inflammation and structural alveolar injury in the peri-atelectasis region may be responsible for pain sensation 2

Management Implications

• When evaluating a patient with chest pain, subsegmental atelectasis should be considered in the differential diagnosis 1
• In patients with known atelectasis who develop chest pain, the pain may be directly related to the atelectasis rather than indicating a new pathology 1
• Treatment should focus on addressing the underlying cause of atelectasis, which may include airway clearance techniques, alveolar recruitment maneuvers, and treatment of any associated infection 3, 4
• For persistent atelectasis causing pain, bronchoscopy may be considered to remove mucus plugs 3, 4

Special Considerations

• Pain from atelectasis may be confused with other causes of chest pain, including pleuritic pain from other conditions 1
• In patients with bronchiectasis who develop chest pain during exacerbations, atelectasis should be considered as a potential cause 1
• The presence of chest pain in a patient with atelectasis may indicate associated complications such as inflammation or infection 1, 2

In conclusion, subsegmental atelectasis can indeed cause chest pain, particularly when associated with inflammation or pleural involvement. The pain is likely due to the mechanical stresses at the interface between collapsed and expanded lung units and the resulting inflammation in the surrounding tissue.