HYDROTORAX - accumulation of non-inflammatory fluid (transudate) in the pleural cavity. It occurs in patients with heart failure in the stage of decompensation, with kidney diseases, liver cirrhosis, alimentary dystrophy, etc. The cause of the accumulation of transudate in the pleural cavity is an increase in hydrostatic pressure in the veins of a large or small circle of blood circulation, a decrease in plasma oncotic pressure as a result of disturbances in protein metabolism and loss of protein in the urine.
Hydrothorax is often bilateral, sometimes right-sided and almost never left-sided. It can be combined with an accumulation of transudate in the abdominal cavity (ascites), in the pericardial cavity (hydropericardium), or with widespread subcutaneous tissue edema (anasarca). Clinically, the development of hydrothorax may initially be asymptomatic. As the transudate accumulates, a feeling of heaviness in the chest appears, shortness of breath increases, the patient takes a sitting position to facilitate breathing. Typically, peripheral edema also increases.
When examining a patient with hydrothorax, the same symptoms are revealed as with exudative pleurisy: limitation of chest mobility during breathing, dull percussion sound at the site of fluid accumulation, tympanic tone of sound above its upper border; breathing in the area of dullness is weakened or not carried out at all, breathing with a bronchial tinge is heard above the upper border of dullness. With unilateral hydrothorax, a shift in the borders of the heart is observed in the direction opposite to the accumulation of transudate.
An X-ray examination shows signs of fluid in the pleural cavities - homogeneous dimming in the lower parts of the pulmonary fields with an oblique outer-upper border. With unilateral hydrothorax, the mediastinal shadow shifts in the direction opposite to blackout.
Patients with suspected hydrothorax need to be hospitalized. In a hospital patient with a large accumulation of fluid in the pleural cavities produce diagnostic pleural puncture. If the fluid obtained by puncture is clear, has a straw-yellow color, its relative density is below 1.015, the protein content is less than 30 g / l, the ratio of the protein content in the pleural fluid to its content in the blood serum is less than 0.5, and the Rivalta test negative, the fluid should be considered a transudate, which confirms the diagnosis of hydrothorax.
When receiving an opalescent or cloudy liquid with a high relative density and protein content, which gives a positive test of Rivalta, you should think about exudative pleurisy.
Treatment of a patient with hydrothorax is aimed at the underlying disease. With a large accumulation of fluid and severe difficulty breathing, unloading pleural punctures are performed, removing once no more than 1 liter of fluid on each side.