HYDROTORAX

HYDROTORAX is an accumulation of non -inflammatory fluid (transudate) in the pleural cavity. It occurs in patients with heart failure in the stage of decompensation, with kidney disease, liver cirrhosis, alimentary dystrophy, etc. The cause of accumulation of the transudate in the pleural cavity is an increase in hydrostatic pressure in the veins of the large or small circle of blood circulation, a decrease in the oncotic pressure of plasma as a result of protein metabolism disorders and Loss of protein in the urine.

Hydrotorax is more often bilateral, sometimes right-sided and almost never left-sided. It can be combined with the accumulation of the transudate in the abdominal cavity (ascites), in the pericardial cavity (hydropericardium) or with the widespread swelling of the subcutaneous tissue (anasarka). Clinically, the development of hydrothorax may initially be asymptomatic. As the accumulation of the transudate, a feeling of heaviness in the chest appears, dyspnea increases, the patient takes a forced sitting position to facilitate breathing. Usually, peripheral edema also increases.

When examining a patient with hydrothorax, the same symptoms are revealed as in exudative pleurisy: limitation of chest mobility during breathing, dull percussion sound in the place of fluid accumulation, tympanic tone of sound above its upper border; Breathing in the area of ​​dullness is weakened or not at all, breathing with a bronchial shade is heard above the upper border of dullness. With a one-way hydrothorax, the boundaries of the heart are shifted in the direction opposite to the accumulation of the transudate.

When X-ray examination, there are signs of the presence of fluid in the pleural cavities - homogeneous darkening in the lower parts of the pulmonary fields with oblique outer-upper boundary. With one-sided hydrothorax, the shadow of the mediastinum shifts in the direction opposite to that of the blackout.

Patients with suspected hydrothorax should be hospitalized. In the hospital, a patient with a large accumulation of fluid in the pleural cavities perform a diagnostic pleural puncture. If the fluid obtained by puncture is clear, has a straw-yellow color, the relative density is less than 1.015, the protein content is less than 30 g / l, the ratio of the protein content in the pleural fluid to its serum content is less than 0.5, and the Rivalta sample Negative, then the fluid should be considered a transudate, which confirms the diagnosis of hydrothorax.

When obtaining opalescent or turbid liquid with high relative density and protein content, which gives a positive Rivalta test, one should think about exudative pleurisy.

Treatment of a patient with hydrothorax is directed to the underlying disease. With a large accumulation of fluid and expressed difficulty in breathing, discharge pleural punctures are performed, removing once not more than 1 liter of liquid from each side.