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Hydrothorax

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

Hydrothorax is more often bilateral, sometimes right-sided and almost never left-sided. It can be combined with the accumulation of transudate in the abdominal cavity (ascites), in the pericardial cavity (hydropericardium), or with widespread edema of the subcutaneous tissue (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, in order to facilitate breathing, assumes a forced sitting position. Peripheral edema usually increases.

When examining a patient with hydrothorax, the same symptoms are revealed as in exudative pleurisy: restriction of the mobility of the chest when breathing, dull percussion sound at the site of fluid accumulation, tympanic hue of sound above its upper limit; breathing in the area of ​​dullness is weakened or not carried out at all; breathing with a bronchial shade is heard above the upper limit of dullness. With unilateral hydrothorax, a shift of the borders of the heart is observed in the direction opposite to the accumulation of transudate.

X-ray examination shows signs of fluid in the pleural cavities — homogeneous darkening in the lower parts of the lung fields with an oblique outer upper limit. With unilateral hydrothorax, the shadow of the mediastinum shifts in the opposite direction to the darkening.

Patients with suspected presence of hydrothorax should be hospitalized. In the hospital, the patient with a large accumulation of fluid in the pleural cavities produce diagnostic pleural puncture. If the fluid obtained during the puncture is transparent, it has straw-yellow color, its relative density is lower than 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 serum is less than 0.5, and the Rivalta sample negative, the fluid should be considered a transudate, which confirms the diagnosis of hydrothorax.

When receiving an opalescent or turbid liquid with a high relative density and protein content, which gives a positive sample of Rivalta, 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 pronounced difficulty breathing, discharge pleural punctures are performed, removing not more than 1 liter of fluid from each side once.