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Bilobar atelectasis after difficult tracheal intubation.

Anaesthesia

December 1997

Cleveland Clinic Foundation, Department of General Anesthesiology, OH 44195, USA.

Acute intra-operative collapse of a lobe without apparent cause is rare. We report a case of transient bilobar atelectasis that developed without any apparent cause after a difficult tracheal intubation in a healthy young patient. Intrabronchial obstruction was ruled out by bronchoscopy.

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Study Objective: To define the most severe form of postlobectomy atelectasis and determine its incidence, predisposing factors, and clinical ramifications.

Design: Retrospective case control.

Setting: The thoracic surgery unit at a 900-bed tertiary care hospital.

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Because of the independent and remote origin of the right upper and middle lobe bronchi, combined collapse of right upper and middle lobes is thought to be uncommon. We report 15 cases of combined right upper and middle lobe collapse found by plain chest radiograph in the past 8 years. Malignancies were confirmed in 13 cases.

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We report here a patient with tracheal and endobronchial metastatic seminoma who presented with acute respiratory failure with right upper and middle lobe collapse. Diagnosis of the etiology of the atelectasis was made by fiberoptic bronchoscopy. Radiation therapy caused a marked reversal of the atelectasis.

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