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Hydrothorax, what is it? Causes, signs and treatment of hydrothorax of the lungs

What it is?

Hydrothorax is a special condition that is manifested by the accumulation of non-inflammatory fluid, or transudate, in the pleural cavity. The pleural cavity surrounds the lungs and is located between two shells, one of which covers the lung tissue directly and is called the visceral pleura, the second lines the inside of the chest and is called the parietal pleura.

Normally, there are a few milliliters of fluid in the pleural cavity to allow the lungs to slide freely while breathing. With hydrothorax, the amount of fluid around the lungs can reach several liters, and can be quite moderate - 10-15 ml.

Hydrothorax of the lungs is a type of manifestation of pleural effusion syndrome. The latter may also be inflammatory, i.e. when exudate accumulates (liquid of inflammatory origin).

Classification

Hydrothorax If hydrothorax is one-sided, then, depending on the side of the lesion, there are left-sided or right-sided hydrothorax.

If the fluid accumulates in the pleural cavity, both to the right and to the left, this is a bilateral hydrothorax, which can be both symmetrical and asymmetric. The latter is the most common.

Content

Causes of hydrothorax of the lungs

Pleural hydrothorax occurs as a result of the liquid part of the blood entering the pleural cavity. This “filtering” can be either with increasing hydrostatic pressure or with increasing pressure due to changes in the chemical properties of blood, i.e., colloid osmotic pressure, in which the fluid leaves the vascular bed into the surrounding tissues with a low amount of protein in the blood.

At the diagnostic stage, hydrothorax is considered to be any accumulation of fluid with unknown properties and from an incomprehensible source. Subsequently, additional research helps to establish the true mechanism of pleural effusion and determine whether it is inflammatory or non-inflammatory.

Causes and mechanism of development of hydrothorax:

  • Chronic heart failure. In this condition, blood stagnation occurs in the large and / or small circulation, which creates conditions for increasing the hydrostatic pressure and causes the passage of fluid into the pleural cavity. The process is usually two-way.
  • Kidney disease with the development of nephrotic syndrome, which is characterized by massive loss of protein in the urine. This becomes the background on which the oncotic pressure decreases, which causes the plasma to enter the pleural cavity.
  • Reduction of oncotic pressure occurs in other pathological conditions - a pronounced lack of thyroid hormones in the stage of myxedema, in which protein metabolism is disturbed; violation of the absorption of protein in the digestive tract, as well as its insufficient intake with food, leading to degeneration. As a result of violations of biochemical processes in these diseases, hypoalbuminemia develops - reducing the amount of protein in the blood plasma, which contributes to the osmotic pressure drop, and the liquid part of the blood leaves the vessels into the pleural cavity.
  • In ascites (pathological accumulation of fluid in the abdominal cavity) and peritoneal dialysis (a special blood purifying procedure performed in case of a malfunction of the kidneys, during which a large volume of fluid is injected into the abdominal cavity), an increase in intra-abdominal pressure and fluid through the pores occurs in the diaphragm diffusion method enters the pleural cavity.
  • Cirrhosis of the liver contributes to the formation of hydrothorax, both due to ascites, and due to hypoalbuminemia, characteristic of this liver disease.
  • Hydrothorax in oncology of the lungs and mediastinal organs occurs due to increased pressure due to impaired lymph and blood circulation (mechanical factor).

Signs and symptoms of hydrothorax

Signs of hydrothorax depend on the amount of accumulated fluid, as well as on the extent of the lesion, and are combined with signs of the disease that caused the accumulation of fluid.

The examination revealed the following specific characteristics characteristic of hydrothorax:

  • Dyspnea, which is different in terms of the rate of increase and intensity, which depends on the nature of the main starting process. Initially occurs during motor activity, and then at rest. Severe shortness of breath speaks of the development of respiratory failure;
  • Cyanosis is cyanotic skin. In moderate cases, especially in heart failure, acrocyanosis is found - cyanosis of the subungual areas, lips, nose, which is also a sign of respiratory failure. With severe heart failure, cyanosis becomes diffuse throughout the body;
  • The lag of the sick half of the chest when breathing, if the process is one-sided. In a two-way process, it is difficult to visually determine the lag;
  • An increase in the volume of one half of the chest. With massive accumulation of fluid, smoothing or bulging of the intercostal spaces is observed;
  • Forced position of the patient on the patient side. With a significant accumulation of fluid on the one hand, this situation helps to ensure greater opening of the healthy part of the lungs during breathing, i.e. it is of a compensatory nature;
  • Along with pneumothorax, hydrothorax can cause compression atelectasis - compression of the lung with loss of airiness and the ability to perform respiratory movements, which manifests as shortness of breath and dry cough, i.e. acute respiratory failure develops;
  • Pain in the chest when formed hydrothorax uncharacteristic. It may appear at the very beginning of the process, or in the period of resorption of fluid, when friction of the pleural sheets against one another is observed;
  • Concomitant edema of the lower extremities is often detected, in severe cases - anasarca - edema of the subcutaneous tissue of the whole body, and also hydropericardium - accumulation of fluid around the heart;
  • During percussion (a method in which the doctor knocks the chest with his fingers), a dull sound is revealed, the upper boundary of which forms a specific bent "Dmuazo line". This method makes it possible to detect even small amounts of fluid better than an X-ray. Conducting percussion when the patient's position is changed gives an offset to the horizontal boundary of the dull sound relative to the body in accordance with the movement of the fluid level;
  • When listening to the lungs (auscultation) over the place of fluid accumulation, either a weakening of the respiratory sounds or their complete absence is detected;
  • Weakening or absence of voice tremor over the lungs on the affected side. The severity of voice trembling is determined by putting his hands on his chest while the patient utters several phrases.

Instrumental and laboratory diagnostics:

X-ray examination reveals the presence of hydrothorax only in cases where the amount of liquid is more than 100-200 ml. On the radiograph, the liquid looks like a uniform darkening, the upper boundary of which is bent in the direction of darkening. With an extensive unilateral hydrothorax, the entire affected half of the chest is darkened, and the organs are shifted to a healthy side.

Conducting research in a direct position is often, and in severe cases, it is necessary to complement it with a laterography, when the patient lies on his side during the picture. At this position, the liquid in the image looks like a dark strip with a horizontal top level.

Using an ultrasound scan of the intended site of hydrothorax, even a small amount of liquid can be determined, starting with 10-15 ml. Also this method helps to identify the best place for the puncture.

To determine the nature of the accumulated fluid make a puncture. This procedure consists in making a puncture of the tissues of the chest wall with a special needle in order to get into the pleural cavity to evacuate the fluid.

Transudate is a light-yellow liquid, odorless, does not form sediment when settling, has a low relative density (1006-1012) and low protein content (about 30 g / l), a small number of cells and low LDH enzyme activity, the content sugar in transudate 3.3 mmol / l and more.

In order to distinguish the transudate from the inflammatory fluid, Rivolt is sampled, which in this case will be negative.

Additional studies that identify the cause of hydrothorax are ecg, echocardiography, ultrasound of the heart, abdominal organs and kidneys, thyroid gland, biochemical analyzes: urea, creatinine, total protein, bilirubin, hormones TSH and T4 St.; tests to determine the functioning of the kidneys.

Treatment of hydrothorax of the lungs

Проводят лечение основного заболевания. 1. They treat the underlying disease.

Пункция при гидротораксе помимо диагностической, является еще и основной лечебной процедурой. 2. Puncture in hydrothorax, in addition to diagnostic, is also the main therapeutic procedure. If there are many liquids, then it is recommended to evacuate no more than 1200 ml of liquid at a time.

Otherwise, a sharp drop in intrapleural pressure on the side of the hydrothorax and the organs moving too fast to the diseased side may occur. After the puncture is performed, a control radiography is performed.

Введение медикаментов в плевральную полость производится на усмотрение лечащего врача в индивидуальном порядке и зависит от причины гидроторакса. 3. The introduction of drugs into the pleural cavity is made at the discretion of the attending physician on an individual basis and depends on the cause of hydrothorax.

Forecast

The puncture greatly facilitates the well-being and facilitates the treatment of the underlying disease. Without treatment, with an increase in the amount of fluid, the development of respiratory failure, the acute form.

Interesting

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