Causes of atelectasis in children

Disorder	Mechanisms/comments
Impaired airway clearance
Perioperative	Contributors to perioperative atelectasis include anesthesia, splinting from pain, and/or use of opioids; each of these factors can impair deep inspiration and cough
Respiratory muscle weakness: Muscular dystrophy Cerebral palsy (severe) Guillain-Barré syndrome Phrenic nerve paralysis	Respiratory muscles are require for lung expansion and effective cough
Abdominal muscle deficit: Prune-belly syndrome High myelomeningocele	Abdominal musculature is required for effective cough
Impaired cough reflex: Post-lung transplant Neurologic conditions that affect afferent or efferent nerves Reduced consciousness Chronic aspiration
Airway obstruction
Intrinsic: Foreign body Mucous plugging Displaced endotracheal tube (eg, right mainstem intubation) Endobronchial tumor (eg, carcinoid, bronchial adenoma) or malformation	Airway obstruction can cause atelectasis and/or hyperinflation: Complete airway obstruction leads to atelectasis, after the distal air is reabsorbed Partial obstruction leads to air trapping and hyperinflation In asthma, mechanisms contributing to airway obstruction include bronchoconstriction, edema, secretion accumulation, and, sometimes, airway remodeling
Intramural: Airway wall edema Bronchoconstriction Bronchiectasis (loss of airway wall integrity) Tracheomalacia/bronchomalacia (if severe) Stricture/scarring
Extrinsic: Hilar lymphadenopathy (malignant or infectious) Cardiomegaly Extramural tumor Cyst Distended pulmonary vessels Hematoma
Lung compression
Intrathoracic tumor Scoliosis Congenital pulmonary airway malformation Pneumothorax Lobar emphysema Empyema Ascites (if severe)	These anomalies directly compress or impair expansion of the nearby lung parenchyma
Parenchymal lung disease
Acute respiratory distress syndrome Pneumonia	Multiple mechanisms: Inflammation inactivates surfactant, which promotes lung collapse (especially in ARDS) Airway wall edema and inflammatory debris/mucus cause airway obstruction

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Causes of atelectasis in children