Obstructive Lung Diseases: Fellow Case Report Poster - Pulmonary Vascular Disease |

Recurrent Lobar Atelectasis in an Adult Asthmatic Patient: The Importance of Collateral Ventilation FREE TO VIEW

Seolhyun Lee, MD; Pedro Dammert, MD; Jonathan Kass, MD
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Cooper University Hospital, Macon, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):911A. doi:10.1016/j.chest.2016.08.1011
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SESSION TITLE: Fellow Case Report Poster - Pulmonary Vascular Disease

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Lobar atelectasis is not an uncommon complication of asthma in children, but is rare in adults. We present a case of recurrent lobar atelectasis in an adult asthmatic patient.

CASE PRESENTATION: A 60-year-old woman presented with right-sided pleuritic chest pain, productive cough, and dyspnea for 2 days. She had asthma for 20 years requiring multiple hospitalizations. She was a non-smoker and her outpatient medications included a long acting beta-agonist/corticosteroid inhaler, montelukast, and short acting beta-agonist as needed. On exam, she was not in respiratory distress, breath sounds were diminished at the right lung base and minimal bilateral expiratory wheezing was noted. Chest roentgenogram showed a triangular haziness at the right lung base obscuring the right heart border and right hemidiaphragm suggestive of right lower lobe (RLL) and RML atelectasis (Figure 1). Bronchoscopy showed complete mucus plugging of the RML and RLL bronchial orifices that reopened after suctioning. In the past 16 months, the patient had 5 hospital admissions for asthma exacerbation with lobar atelectasis involving separately each one of the three lobes of the right lung and twice involving the RML and RLL at the same time (Figure 2). Atelectasis resolved after bronchoscopic removal of mucous plugs on those episodes. During this admission, the patient had significant clinical and radiographic improvement after bronchoscopy. She was discharged with her asthma medications and VEST chest physiotherapy at home.

DISCUSSION: Obstructive segmental and lobar atelectasis from mucus plugging during asthma attacks is common in children as they have poorly developed pores of Kohn and canals of Lambert. These structures are well developed in adults and allow for intra-lobar collateral ventilation. Another important factor in collateral ventilation is the lack of integrity of the interlobar fissures, which can occur in up to 70% of adult population allowing for interlobar collateral ventilation. This patient had complete right major and minor fissures which could explain her propensity to atelectasis.

CONCLUSIONS: Recurrent atelectasis from mucus plugs is uncommon in adult asthmatic patients as there are mechanisms for intra and interlobar collateral ventilation. The treatment is bronchoscopic suctioning of mucus plugs and chest physiotherapy.

Reference #1: Pickup CM, Nee PA, Randall PE. Radiographic features in 1016 adults admitted to hospital with acute asthma. J Accid Emerg Med. 1994 Dec;11(4):234-7.

DISCLOSURE: The following authors have nothing to disclose: Seolhyun Lee, Pedro Dammert, Jonathan Kass

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