Text book of veterinary medicine, Volume 1 (of 5)

by James Law

ATELECTASIS. COLLAPSE OF LUNG.

Atelectasis in bronchitis, congenital, etc. Airless condition in the absence of exudation. Causes, congenital persistence in butcher animals. Blocking of air tubes by exudate—ball valve. Desquamation of ciliated epithelium. Compression by hydrothorax, pneumothorax, and false membrane. Symptoms. Percussion flatness, juvenile respiration elsewhere, blowing sounds loud. Drum-like sounds on emphysema and pneumothorax. Cyanosis. Lesions, depressed, flesh-like, non-crepitating lobules or lobuletes, sink in water, dilatable. Treatment, rouse respiratory centres, douches, cold and warm, slapping, electricity, forced inspiration, diet, massage. Treat attendant disease.

This has been already referred to as a result of bronchitis, but it deserves special mention as a sequel of that affection, and in various domestic animals, as an independent condition. The condition is one of consolidation of lung by the complete exclusion of air, but without any infiltration of its substance by inflammatory exudate or dropsical effusion. The tissue remains in its normal state apart from the fact that its bronchioles and air sacs are undilated. The affected portion has a solid dark fleshy appearance. The collapsed portion often represents one lobule or group of lobules which communicate with a single bronchium.

Causes. In some instances the conditions remain from birth, the lobule never having been called into use. This is seen especially in cattle and other meat producing animals, in which active breathing is systematically suppressed in the interests of rapid growth and the deposition of fat. In the improved breeds the lungs remain larger than the exigencies of the life demand, and large portions remain out of use. In bronchitis the condition is acquired, and is mainly dependent on the blocking of a bronchial tube with tenacious mucus or a desiccated mass. The pathological lesions of bronchitis favor this since one of the earliest changes in the inflamed mucosa is the desquamation of the columnar epithelium. This removal of much of the cilia and the paralysis of much of what is left annihilates for a time the normal method of clearing away the secretion, and this being now produced in excess blocks the tubes. This secretion virtually acts like a ball valve in favoring the exit of the air during the convulsive expiration of coughing, and hindering its entrance during the succeeding inspiration. The bronchia and bronchioles decrease in size to near their termination, so that, as forced out in coughing, the secretion enters the larger tube and allows the exit of air, which as drawn back in inspiration it enters the smaller tube and closes it against any possible ærial entrance. Mendelssohn and Traube demonstrated this action by introducing a shot into a dog’s lung, and in two days the left lung was found collapsed and the right one the seat of complementary emphysema. The violence and frequency of the cough therefore bears a ratio to the occurrence and extent of atelectasis. Other causes are the compression of the lower lobes of the lung by hydrothorax, by pneumothorax (developed by lacerated lung or perforated chest wall) or by a false membrane contracting in process of organization.

Symptoms. As a congenital condition in the improved meat producing animals the condition is rarely recognized in life and cannot be said to be a defect. The collapsed lobule being farther removed from the air may be a more favorable field for the growth of pathogenic bacteria, but on the other hand these do not so readily penetrate it as if the tubes were open. When the collapse is more extensive, the contrast in the flatness on percussion and indistinctness of the respiratory murmur on the affected side, and the marked resonance and loud murmur on the other, may serve to identify the affection. In extensive, traumatic cases this contrast is much more prominently marked, as the expanded portions have to take on extra compensatory work and are not infrequently rendered emphysematous. The drum-like sound in percussion of such parts, and in the upper part of the chest in pneumothorax are pathognomonic of these conditions. Again in hydrothorax the horizontal upper level of the area of dulness betrays a liquid cause. Severe cases are marked by cyanosis.

The lesions seen in atelectasis consist in depressed areas of a dark fleshy color on the surface of the lung, usually sharply limited by the borders of the lobules, and in strong contrast with the bulging, light colored lobules adjacent, which are often emphysematous. The collapsed lobule may usually be dilated when air is forced into the bronchium, but if it has been of some standing this is often difficult or impossible. If it has resulted from bronchitis or compression of a previously inflated lung it will often float in (not on) water, from a little retained air, but in congenital atelectasis it is airless and sinks to the bottom.

When treatment is demanded it will vary according to the cause. In congenital atelectasis the respiratory centres must be roused. The new born animal may be sprinkled alternately with ice cold and hot water, or the chest may be slapped with the palm of the hand or a wet towel. The nostrils must be cleared of mucus, and the lungs inflated by blowing or bellows, the larynx being pressed back against the gullet to prevent inflation of the stomach. If available electricity may be applied to the chest walls. These measures may be repeated at intervals and the systemic weakness overcome by nourishing food, stimulants and friction of the skin.

In acquired atelectasis we should seek to correct the disease to which it owes its existence. In bronchitis the measures already indicated for the liquefaction and removal of the expectoration will be in order; in hydrothorax a judicious paracentesis and in pneumothorax the aspiration of the gas, and the closure of any traumatic opening through which that gas has gained access.