Pulmonary atelectasis due to organised blood clot
J Harikrishna1, V Pradeep1, G Mounika1, S Lavanya1, K Hemsai1, C Sunil Kumar1, B Vijayalakshmi Devi2
1 Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Radiodiagnosis, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
|Date of Web Publication||8-Apr-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Harikrishna J, Pradeep V, Mounika G, Lavanya S, Hemsai K, Kumar C S, Devi B V. Pulmonary atelectasis due to organised blood clot. J Clin Sci Res 2018;7:149-50
|How to cite this URL:|
Harikrishna J, Pradeep V, Mounika G, Lavanya S, Hemsai K, Kumar C S, Devi B V. Pulmonary atelectasis due to organised blood clot. J Clin Sci Res [serial online] 2018 [cited 2019 Apr 9];7:149-50. Available from: http://www.jcsr.co.in/text.asp?2018/7/3/149/255664
A 79-year-old female patient presented to the emergency department at our tertiary care teaching hospital with a history of shortness of breath and fever for 3 days. In view of respiratory distress, she was intubated and was started on mechanical ventilator support. On further evaluation, she was found to have community-acquired pneumonia due to influenza A virus infection, and she was shifted to the medical intensive care unit for further management. She developed sepsis with multiorgan dysfunction; she was managed accordingly with antibiotics and other supportive measures. Tracheostomy was done on day 9; 3 days following that, she became tachypneic, and on clinical examination, breath sounds were diminished all over the lung fields on the left side. Chest X-ray was done and it revealed left lung absorption atelectasis [Figure 1]. An organized blood clot was removed on repeated suctioning with mucolytic agents and following that recruitment maneuvers resulted in expansion of collapsed lung [Figure 2]. She was weaned off from the ventilator support, and after decannulation of the tracheostomy tube, she was discharged in hemodynamically stable condition. On follow-up, she was doing well.
|Figure 1: Chest radiograph in anteroposterior view of the patient showing diffuse opacification of the left hemithorax|
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|Figure 2: Chest radiograph in anteroposterior view of the same patient showing expansion of the left lung following the removal of a blood clot|
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Although bronchial intubation of the right side most often leads to acute left lung collapse, the possibility of other causes such as obstruction of left bronchus due to mucus plug, blood clot, foreign body aspiration, and large pleural effusion should be considered. Management includes chest physiotherapy, repeated manual lung inflation with frequent suctioning, and postural change with mechanical ventilator support to maintain adequate ventilation. Fiberoptic bronchoscopy remains the method of choice for both diagnosis and treatment of lung collapse due to obstruction if above measures fail. The present case highlights the importance of meticulous clinical examination, and timely management of acute lung collapse results in decreased morbidity and better outcome in patients with absorption atelectasis.
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[Figure 1], [Figure 2]