Abstract / Summary
Abstract Background: Acute lung atelectasis caused by airway mucus plugging is a potentially reversible cause of respiratory failure, particularly in postoperative and critically ill patients. Prompt recognition and timely intervention are essential to prevent prolonged hypoxemia, mechanical ventilation, and other serious complications. Flexible bronchoscopy is considered the gold standard for diagnosing and treating obstructive atelectasis by directly identifying and removing airway obstruction. Case Presentation: A 32-year-old man developed severe hypoxemia and complete right lung atelectasis on the second day following exploratory laparotomy for abdominal trauma. Despite chest tube insertion, invasive mechanical ventilation, and supportive management, oxygenation remained critically impaired. Bedside lung ultrasonography demonstrated extensive right lung collapse. Therapeutic flexible bronchoscopy revealed complete obstruction of the right upper lobe bronchus by a thick mucus plug, with additional retained secretions in the right bronchial tree. Bronchial toilet and suctioning successfully restored airway patency. Immediate post-procedure chest radiography demonstrated significant right lung re-expansion, while arterial oxygenation improved markedly, with PaO₂ increasing from 40 mmHg to 194 mmHg. The patient was subsequently weaned from mechanical ventilation, experienced progressive clinical recovery, and was discharged from the intensive care unit in stable condition.
Conclusion: This case highlights that mucus plug-induced atelectasis should be considered in postoperative patients presenting with sudden hypoxemia and radiographic evidence of lung collapse. Early therapeutic flexible bronchoscopy provides both definitive diagnosis and effective treatment by restoring airway patency, promoting rapid lung re-expansion, improving oxygenation, facilitating ventilator weaning, and optimizing clinical outcomes when conservative management is unsuccessful.