Lobar And Pulmonary Collapse

When a bronchus is blocked, the area of the lung beyond it loses its aeration and collapses. This gives a characteristic appearance on the chest radiograph (Fig. 18.8). If the whole lung collapses there is an associated mediastinal shift to that side and hyperexpansion of the other lung.

In young patients, the cause is most likely to be an inhaled foreign body or postinfective stricture, but in older patients the most likely cause is bronchogenic carcinoma. Patients with severe asthma may get plugs of tenacious sputum which block the bronchus.

A collapsed area of lung leads to breathlessness as there is continued pulmonary blood flow in that part without any corresponding aeration and it is also liable to become infected. A patient with a collapsed lobe should have a bron-choscopy, both as a diagnostic and a possible therapeutic procedure.

The best management of lung cancer is to resect it but if this is not feasible intrinsic endobronchial cancers can be resected with a laser or removed manually with biopsy forceps. Sometimes these blockages are due to extrinsic compression in which cases, if there is a useful distal lumen, a stent can be inserted.

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