From the Guidelines
Right perihilar subsegmental atelectasis is a partial collapse of a small section of lung tissue that can be caused by blockage of a small airway from mucus plugging, inflammation, or external compression, and is often incidental and temporary, resolving on its own without specific treatment. This condition occurs when the tiny air sacs (alveoli) in a portion of the lung become deflated or airless, and it is typically found in the perihilar region, which is the area around the hilum where blood vessels and airways enter the lungs. According to the study by 1, disorders in which the small airways are neither dilated nor inflamed, such as cryptogenic bronchiolitis obliterans, may show no direct radiographic abnormalities and may only be inferred by indirect features such as air-trapping (mosaic attenuation on expiration scans) or subsegmental atelectasis.
Some key points to consider in the management of right perihilar subsegmental atelectasis include:
- Addressing the underlying cause, which might include deep breathing exercises, incentive spirometry, or treatment of any respiratory infection if present 1
- Considering the use of chest physiotherapy to promote airway clearance, although the evidence for its benefit is limited 1
- Avoiding routine use of "deep" suctioning, as it may not be beneficial and could potentially cause harm 1
- Identifying any underlying conditions that might have caused the atelectasis, such as pneumonia, bronchitis, or other respiratory issues, in order to provide appropriate treatment and prevent further complications.
It's worth noting that the study by 1 found that airway edema, sloughing of respiratory epithelium into airways, and generalized hyperinflation of the lungs, coupled with poorly developed collateral ventilation, put infants with bronchiolitis at risk for atelectasis, and that chest radiographs may show evidence of subsegmental atelectasis. However, the study also found that there is no clinical benefit to using vibration or percussion, or passive expiratory techniques, in hospitalized patients with bronchiolitis.
From the Research
Definition of Atelectasis
- Atelectasis refers to a state of collapsed and non-aerated region of the lung parenchyma, which is otherwise normal 2.
- It is a pathological condition usually associated with several pulmonary and chest disorders and represents a manifestation of the underlying disease, not a disease per se 2.
Types and Mechanisms of Atelectasis
- Atelectasis can be divided into types such as segmental, lobar, or whole lung; subsegmental; platelike, linear, or discoid; round; and generalized or diffuse 3.
- The mechanisms leading to atelectasis include resorption atelectasis, adhesive atelectasis, passive atelectasis, compressive atelectasis, cicatrization atelectasis, and gravity-dependent atelectasis 3.
Right Perihilar Subsegmental Atelectasis
- Subsegmental atelectasis refers to the collapse of a portion of a lung segment 3.
- Right perihilar subsegmental atelectasis specifically refers to the collapse of a subsegment of the lung located near the hilum (the part of the lung where the bronchi, blood vessels, and nerves enter) on the right side.
- The term "perihilar" indicates that the atelectasis is located near the hilum, and "subsegmental" indicates that it affects a portion of a lung segment 3.
Diagnosis and Treatment
- Chest radiographs using both the anterior-posterior and lateral projections are mandatory to document the presence of atelectasis 2.
- The treatment of atelectasis varies depending on the duration and severity of the causal disease, and may include chest physiotherapy, postural drainage, bronchodilator and anti-inflammatory therapy, and bronchoscopy to remove persistent mucous plugs 2, 4, 5.