What diseases cause hydrothorax of the lungs on the left? Hydrothorax of the lungs: causes, symptoms, diagnosis, treatment. What is pathology

Hydrothorax (chest dropsy) - accumulation of fluid is not inflammatory in nature and origin (transudate) in the pleural cavities.

Causes of hydrothorax

Hydrothorax may occur during decompensation of heart failure with the development of congestion in big circle blood circulation; for kidney diseases accompanied by the development of nephrotic syndrome (glomerulnephritis, renal amyloidosis and others); with cirrhosis of the liver, with myxedema (a disease caused by insufficient production of hormones thyroid gland); in the presence of large tumors in the mediastinum (anatomical space in the middle sections chest cavity, limited in front by the sternum and behind by the spine), compressing the superior vena cava and brachiocephalic veins. The accumulation of non-inflammatory fluid in the pleural cavities in some cases can be observed with nutritional dystrophy, caused by a severe lack of vitamins B and C, as well as due to impaired lymph outflow.

Symptoms of hydrothorax

The main manifestations of hydrothorax are caused by the dynamic accumulation of fluid in the pleural cavities and compression of the lungs by it, as well as displacement of the mediastinal organs. The onset of the disease is usually gradual. With an increase in the amount of transudate in the pleural cavities, a feeling of heaviness in the chest appears, the severity of the subjective feeling of lack of air increases, which is accompanied by an increase in frequency and depth breathing movements. Cyanosis (bluish coloration of the skin caused by the accumulation of carbon dioxide in the blood) appears and intensifies.

Painful sensations in the chest are not typical. With a significant accumulation of fluid, protrusion and limited mobility of the corresponding half are determined chest and its lag in the act of breathing from healthy, as well as smoothness intercostal spaces on the sore side. In a lying position, it is easier for the patient to be on the affected side, as this does not lead to difficulty breathing. With very large volumes of liquid, the patient tries to take a semi-sitting position. Body temperature, as a rule, does not increase.

Survey

More often, hydrothorax is bilateral and is often accompanied by hydropericardium (fluid accumulation in the pericardial sac) and ascites (fluid accumulation in the abdominal cavity).
In making a diagnosis great importance have X-ray examination chest, ultrasound examination (US) of the pleural cavities and computed tomography (CT) of the chest organs. Radiologically, hydrothorax is manifested by a uniform darkening occupying the lowest located sections pleural cavity; this darkening moves freely with changes in body position. Ultrasound reveals free fluid in the pleural cavity, and a more accurate assessment of its volume is possible. CT may detect, in addition to free fluid in the pleural cavity, some of the causes that caused the development of hydrothorax (for example, tumors or enlarged mediastinal lymph nodes compressing the superior vena cava).

Treatment of hydrothorax

Treatment for hydrothorax comes down to therapeutic measures and pleural puncture.
Therapeutic measures are aimed at treating the underlying disease that caused the development of hydrothorax.

So, in case of hydrothorax, caused by the presence of heart failure in the patient, the patient is recommended to optimize the work and rest regime, eliminate psycho-emotional stress conditions, normalization of sleep. Prescribed diet No. 10 or No. 10a with limited water intake and table salt, and the meals themselves should be fractional (up to 5-6 times a day, eating a small amount of food at one meal).

Drug treatment can be aimed at enhancing the reduced contractility of the myocardium (prescribe cardiac glycosides, β-adrenergic receptor stimulants, phosphodiesterase inhibitors), diuretics, reducing the load on the left ventricle of the heart (peripheral venous, arterial and mixed vasodilators, ACE inhibitors).

With a significant accumulation of fluid in the pleural cavity, leading to compression of the lungs and the development of respiratory failure, resort to pleural puncture with slow removal of transudate from the pleural cavity. This therapeutic manipulation is at the same time diagnostic, since the nature of the resulting fluid and its results laboratory research make it possible to distinguish hydrothorax from exudative pleurisy, hemothorax, pleural empyema.

With the recurrent nature of hydrothorax, according to indications, they resort to repeated punctures of the pleural cavity, sometimes more than once.

Hemothorax– intrapleural bleeding, leading to accumulation of blood in the pleural cavity, which is accompanied by compression of the lung and displacement of the mediastinal organs to the opposite side.

Causes of hemothrax

There are three groups of causes that most often lead to the development of hemothorax: traumatic, pathological and iatrogenic.

Under traumatic causes understand penetrating injuries or closed damage chest. Thoracic trauma accompanied by the development of hemothorax includes road accidents, gunshots and stab wounds chest, rib fractures, falls from a height, etc. With such injuries, damage to the organs of the chest cavity (heart, lungs, diaphragm), abdominal organs (injuries of the liver, spleen), intercostal vessels, internal thoracic artery, intrathoracic branches of the aorta, blood from which flows into the pleural cavity.

Pathological causes of hemothorax include various diseases: aortic aneurysm, pulmonary tuberculosis, lung cancer or pleura, lung abscess, mediastinal neoplasms and chest wall, hemorrhagic diathesis, coagulopathy, etc.

Iatrogenic factors leading to the development of hemothorax are complications of operations on the lungs and pleura, thoracentesis, drainage of the pleural cavity, and catheterization of the central veins.

Pathogenesis of hemothorax

The accumulation of blood in the pleural cavity causes compression of the lung on the affected side and displacement of the mediastinal organs in the opposite direction. This is accompanied by a decrease in the respiratory surface of the lung, the occurrence of respiratory and hemodynamic disorders. Therefore, with hemothrax, a clinical picture of hemorrhagic and cardiopulmonary shock with acute respiratory and heart failure often develops.

Within the next few hours after blood enters the pleural cavity, aseptic inflammation of the pleura develops - hemopleuritis, caused by the reaction of the pleural layers. With hemothorax, swelling and moderate leukocyte infiltration pleura, swelling and desquamation of mesothelial cells. Once in the pleural cavity, the blood first coagulates. However, then the process of fibrinolysis soon begins, and the blood thins again. This is facilitated by anticoagulant factors contained in the blood and pleural fluid itself, as well as mechanical defibrination of blood due to breathing excursion chest. As the anticoagulation mechanisms are exhausted, blood clotting occurs and a clotted hemothorax is formed. In the case of microbial infection associated with hemothorax, pleural empyema can occur quite quickly.

Classification of hemothorax

In accordance with the etiology, traumatic, pathological and iatrogenic hemothorax are distinguished.

Taking into account the magnitude of intrapleural bleeding, hemothorax can be:

· small - the volume of blood loss is up to 500 ml, accumulation of blood in the sinus;

medium - volume up to 1.5 l, blood level to the lower edge of the 4th rib;

· subtotal - the volume of blood loss is up to 2 liters, the blood level is up to the lower edge of the second rib;

· total - the volume of blood loss exceeds 2 liters, radiographically characterized by total darkening of the pleural cavity on the affected side.

In addition, limited (usually small in volume) hemothorax is also isolated, in which the spilled blood accumulates between pleural adhesions, in an isolated area of ​​the pleural cavity. Depending on the location, limited hemothorax can be apical, interlobar, paracostal, supradiaphragmatic, paramediastinal.

In the case of continuing intrapleural bleeding, we speak of an increasing hemothorax, in the case of cessation of bleeding - a non-increasing (stable) hemothorax. Complicated types include coagulated and infected hemothorax (pyohemothorax). When air and blood enter the pleural cavity at the same time, they speak of hemopneumothorax.

Symptoms of hemothorax

With small hemothorax, clinical manifestations are minimal or absent. The main complaints are chest pain, aggravated by coughing, and moderate shortness of breath.

For hemothorax of moderate or big size respiratory and cardiovascular disorders develop, expressed in varying degrees. Characteristic sharp pain in the chest, radiating to the shoulder and back when breathing and coughing; general weakness, tachypnea, decreased blood pressure. Even with minor physical activity symptoms increase. The patient usually takes a forced sitting or semi-sitting position.

In severe hemothorax, the clinic of intrapleural bleeding comes to the fore: weakness and dizziness, cold sticky sweat, tachycardia and hypotension, pallor skin with a cyanotic tint, flickering spots before the eyes, fainting.

Hemothorax associated with rib fractures is usually accompanied by subcutaneous emphysema, soft tissue hematomas, deformation, pathological mobility and crepitus of rib fragments. With hemothorax occurring with rupture of the pulmonary parenchyma, hemoptysis may occur.

With infected hemothorax (pleural empyema), signs of severe inflammation and intoxication come to the fore: fever, chills, lethargy, etc.

Diagnosis of hemothorax

With hemothorax, the affected side of the chest lags when breathing, dullness of percussion sound above the fluid level, weakening of breathing and vocal tremor. With fluoroscopy and plain radiography lungs, collapse of the lung, the presence of a horizontal level of fluid or clots in the pleural cavity, flotation (displacement) of the mediastinal shadow to the healthy side are revealed.

WITH diagnostic purpose a puncture of the pleural cavity is performed: obtaining blood reliably indicates hemothorax. In case of banal and coagulated hemothorax, they resort to laboratory determination of Hb, the number of erythrocytes, platelets, and the study of a coagulogram. Additional instrumental diagnostics for hemothorax may include ultrasound of the pleural cavity, radiography of the ribs, CT scan of the chest, diagnostic thoracoscopy.

Treatment of hemothorax

Patients with hemothorax are hospitalized in specialized surgical departments and are under the supervision of a thoracic surgeon.

WITH therapeutic purpose for aspiration/evacuation of blood, thoracentesis or drainage of the pleural cavity is performed with the introduction of antibiotics and antiseptics into the drainage (to prevent infection and sanitation), proteolytic enzymes (to dissolve clots). Conservative treatment hemothorax includes hemostatic, disaggregant, symptomatic, immunocorrective, blood transfusion therapy, general antibiotic therapy, oxygen therapy.

Hydrothorax – pathological condition, in which non-inflammatory fluid (transudate) accumulates in the pleural cavity.

Causes and mechanisms of development

Pleural effusion, as a rule, is secondary in nature and can accompany the course of various diseases:

• circulatory failure with congestion in the systemic circulation;
• liver cirrhosis with ascites;
• myxedema;
• constrictive pericarditis;
• pulmonary embolism;
• hypoproteinemia;
• nephrotic syndrome;
• glomerulonephritis;
• hemodialysis and peritoneal dialysis;
• nutritional dystrophy.

Normally, fluid in the pleural cavity is produced in the apical part of the parietal layer of the pleura, and its drainage occurs through lymphatic vessels the same section of the pleura. U healthy person located in the pleural cavity a small amount of fluid that allows the layers of the pleura to slide relative to each other. The circulation of this fluid is ensured by the complex interaction of a number of mechanisms:

• the difference between the osmotic pressure of the fluid contained in the pleural cavity and the oncotic pressure of the blood plasma;
• certain values ​​of hydrostatic pressure in the vascular bed of the parietal pleura;
• features of the viscosity distribution of pleural fluid;
• ensuring the biomechanism of breathing and normal lung excursion.

A disruption in one of these mechanisms can lead to fluid accumulation in the pleural cavity.

The main causes of hydrothorax are:

• an increase in hydrostatic pressure in the capillary network of the visceral and parietal pleura;
• decrease in oncotic pressure in blood plasma;
• increased permeability of the vascular wall;
• disorders of lymphatic drainage at various levels (compression of the mediastinum by a tumor or aortic aneurysm);
• disturbances in electrolyte metabolism;
• increased aldosterone production.

Clinical manifestations

Hydrothorax, regardless of the cause of its occurrence, has a typical clinical picture. Such patients complain of difficulty breathing, a feeling of heaviness and discomfort in the chest. At the same time, it is of a mixed nature and intensifies in the lying position.

During an objective examination, the doctor can identify the following signs of the presence of fluid in the pleural cavity:

1. Changes in the shape of the chest and its asymmetry with unilateral lesions.
2. Lagging of the “sick” half in the act of breathing.
3. Smoothness of intercostal spaces.
4. Tachypnea.
5. Marked resistance of the chest.
6. Absence of vocal tremors and respiratory sounds over the pathological focus.
7. Dullness of percussion sound.
8. Sharp limitation of mobility of the lower edge of the lung.

Hydrothorax is most often right-sided (but can also be bilateral) and is combined with fluid accumulation in other serous cavities.

Diagnostics

Diagnosis of hydrothorax is based on clinical manifestations illness (patient complaints, medical history, physical examination data) and the results of additional research, which includes:

• (executed in vertical position and on the side; reveals smoothness of the costophrenic angle and darkening in the area of ​​fluid accumulation);
• Ultrasound of the pleural cavity (allows you to detect effusion with a volume of 100-200 ml);
• computed tomography (more informative method, makes it possible to determine the minimum volume of fluid contained in the pleural cavity);
• and analysis of its contents (clarifies the nature pleural effusion; carried out in the 7-8 intercostal space along the posterior axillary or scapular line).

The presence of transudate in the pleural cavity is evidenced by the nature and properties of the fluid obtained during a diagnostic puncture. It is a transparent yellowish liquid with a relative density of less than 1.015, a protein concentration of less than 30 g/l, and a relatively low content of leukocytes and erythrocytes.

Treatment

• The first priority in the treatment of hydrothorax is treatment of the underlying disease.
• Additionally, diuretics may be prescribed.
• In case of massive hydrothorax, a puncture is performed to remove pathological contents from the pleural cavity to alleviate the patient’s condition. Moreover, no more than 1.5 liters of pleural fluid can be removed at a time.

It should be noted that puncture of the pleural cavity is not performed on all patients; for some of them it is contraindicated.

Under the term "hydrothorax" (according to at least, V radiology diagnostics) refers to a condition in which there is fluid of any nature in the chest cavity. This can be exudate, transudate, blood, lymph, bile, pus, etc. The nature of the fluid in the chest cavity using x-ray examination it is difficult to establish (one can only guess), therefore, when describing radiographs (and CT scans), only the volume is indicated (approximately with radiographs, more precisely plus or minus 100 ml with CT), as well as the localization of the liquid contents.

The causes of hydrothorax can be either therapeutic pathology ( congestion in the vessels of the pulmonary circulation), as well as tumor pathology (for example, metastases in the pleura provoke the development of hydrothorax of varying volume), acute surgical pathology ( acute pancreatitis often causes the accumulation of inflammatory fluid in the left half of the chest). Trauma to the chest with damage to the ribs and pleura is another reason for the accumulation of fluid (here it is more likely to be hemorrhagic) in the chest cavity.

Hydrothorax can be classified according to the nature of the fluid (determined after puncture). Hemothorax is an accumulation of blood in the chest cavity, chylothorax is an accumulation of lymph, pyothorax is pus. Hydrothorax is also divided according to the volume of liquid - minimal hydrothorax is isolated (50-100 ml), which can only be detected with computed tomography, hydrothorax of small volume (up to 500 ml), which can be detected already on x-ray chest, medium hydrothorax (500-1500 ml), giving a detailed X-ray picture, and large-volume hydrothorax (over 1500 ml), leading to compression of the lung and respiratory impairment.

This is what hydrothorax looks like on an x-ray (in direct projection) - in the left image. The arrow marks a shadow with a horizontal upper border on the right in lower parts- This is a sign that there is also gas in the chest cavity. In the image on the right - signs of hydrothorax on CT (mediastinal mode) - arrows indicate fluid with a density of +8...+10 Hounsfield scale units.

Hydrothorax: signs on radiographs

Depending on the volume, location of the fluid, and the presence of air in the chest cavity, hydrothorax may look different on radiographs. The most characteristic, “classic” sign of hydrothorax in a direct projection image (necessarily taken with the patient standing) is a darkening of medium intensity with an inclined upper border, the outer edge of which is higher than the inner one - such a border is due to lower (compared to atmospheric) pressure in the pleural cavity and indicates the absence of gas in it. If there is gas in the chest cavity, the border of the darkening becomes straight (horizontal).

On radiographs, fluid in the chest cavity is marked by arrows (along the upper border). On the left - in direct projection, the shadow has an inclined upper border, the outer edge of which is located higher, which indicates the absence of air in the chest cavity.

These radiographs also demonstrate left-sided hydrothorax in another patient, showing opacification with a sloping border on the left in the lower regions.

If the fluid is localized in the area of ​​the anterior (or lateral) costophrenic sinus (or in both sinuses), the border of the darkening will be clear. In cases where the fluid is located behind, on radiographs the border of the darkening “blurs” and becomes unclear - in this case, a picture in a lateral projection is necessary to differentiate hydrothorax from pneumonic lung infiltration, and also reliably indicate to surgeons its location. Unfortunately, the volume of liquid can only be determined approximately on radiographs - the accuracy does not exceed plus or minus 500 ml (in ideal cases). To more accurately determine the volume, a CT scan is recommended.

The radiograph does not clearly visualize the right lateral costophrenic sinus, the contour of the dome of the diaphragm with right side fuzzy – this state may be caused by both right-sided hydrothorax and pneumonia. Here it is necessary to perform a lateral view and a CT scan of the chest.

Hydrothorax of large volume right-sided localization

These images demonstrate the dynamics of a patient's left-sided hydrothorax before (left image) and after treatment (right image). Notice how the edge of the shadow on the left side has moved downwards - however, there is still fluid in the chest.

X-rays show signs of large volume hydrothorax on the right side. A shadow with an inclined upper border (marked by arrows) is clearly visualized. It can be assumed that the volume of fluid inside the chest is more than 1.5 liters.

Medium hydrothorax on the right: a shadow with an almost horizontal border is visible on the direct projection image (left)

Radiographs demonstrating hydropneumothorax: in the image on the left with arrows yellow color The level of fluid in the chest cavity is marked, green arrows indicate the edge of the compressed lung, and number 1 indicates air in the chest cavity.

Signs of hydrothorax on CT scan

On computed tomography, hydrothorax manifests itself as the presence of liquid contents in the chest cavity with a density of +5 to +20 Hounsfield units.

This is what hydrothorax looks like on a CT scan. Number 1 indicates a liquid with a density of +8...+10 units (Hounsfield), occupying most of the volume of the left half of the chest cavity and causing compression of the lung (in the left image and the image in the middle). The image on the far right shows minimal hydrothorax (fluid indicated by arrows).

Hydropneumothorax on CT: yellow arrows indicate the level of fluid in the chest cavity (in both images), on the right image number 1 indicates free gas in the chest, arrows of blue color- the edge of a slightly compressed lung. This condition is caused by an attempt surgical treatment hydrothorax - evacuation of fluid using puncture. The fluid was not completely evacuated, but as a result of a violation of the integrity of the chest wall and pleural cavity, gas entered it, causing some compression of the lung on the right.

The scans presented may suggest hemothorax. Number 1 on the left image indicates a fluid component in the chest cavity, green arrows on the image in the middle indicate subcutaneous emphysema, and a yellow arrow on the right image indicates a rib fracture (one of many in this patient) - all these are consequences of chest trauma.

The group of respiratory pathologies includes hydrothorax of the lungs. This condition is characterized by the accumulation of fluid in the pleural cavity. The human lungs are paired organ. They are located in the chest cavity. The outside of the lungs is covered with pleura. Its leaves form a small cavity in which liquid can accumulate. IN severe cases this condition requires emergency care(puncture followed by drainage).

Hydrothorax is a pathological condition in which transudate accumulates in the pleural cavities. The latter must be distinguished from exudate. Transudate is non-inflammatory in nature. In ICD-10, the code for this pathology is J94.9. Hydrothorax of the lungs can occur in people of any age. This syndrome There are several types. There are two most common types - hemothorax and chylothorax. In the first case, blood accumulates, and in the second, lymph accumulates.

Most often, unilateral hydrothorax is detected. This pathology detected during instrumental examination (radiography, MRI or CT). In the absence of proper treatment, this disease can cause the joining secondary infection and the development of heart failure. In severe cases, a condition called hydropericardium develops. With it, fluid accumulates in the pericardial sac.

The causes of this pathology are not known to everyone. Lung damage on the left or right is most often caused by serious illnesses. The greatest role in the development of this pathology is played by:

• congestive heart failure;
• defects in the stage of decompensation;
• tumors;
• kidney pathology;
• liver diseases;
• myxedema;
• ovarian fibroma;
• increase in blood pressure in the pulmonary artery system.

With hydrothorax, the permeability of small blood vessels. This occurs as a result of changes in oncotic and osmotic pressure. These indicators largely depend on the functioning of the heart, liver and kidneys. The decrease in oncotic pressure is based on protein loss. This is possible against the background of glomerulonephritis or amyloidosis.

It is known that protein is synthesized in the liver. With cirrhosis or other pathology, this process is disrupted, which leads to a decrease in oncotic pressure. Signs of hydrothorax appear only when a large volume of fluid accumulates. In this case, breathing is impaired. Most often with hydrothorax, transudate is found on the right. Often both lungs are affected.

With the development of hydrothorax, the symptoms are not always pronounced. The following clinical manifestations are possible:

• dyspnea;
• feeling of heaviness in the chest;
• forced body position.

In severe cases, ascites develops. With it, fluid accumulates in the abdominal cavity. If both lungs are affected, the patient's condition is more severe. This syndrome leads to displacement of the mediastinal organs and compression of tissues. In most cases, the symptoms of hydrothorax increase gradually. The main symptom is shortness of breath.

It is associated with impaired lung function. Patients complain of a feeling of lack of air. Gradually breathing becomes more frequent and deeper. This can be detected during a physical examination. Bilateral hydrothorax in the absence of proper assistance, it can lead to cyanosis. The reason is the accumulation of carbon dioxide in the blood. This is manifested by cyanosis of the skin.

Bilateral pathological process does not manifest itself as pain. This is different from inflammatory diseases. The affected half of the chest lags behind the healthy half when breathing. This syndrome often causes sick people to take an elevated posture. top part torso. There are no symptoms of intoxication such as fever and chills. In severe cases, complications may develop in the form of purulent pleurisy, respiratory failure and ascites.

You need to know not only what hydrothorax is, but also methods for diagnosing this pathology. At the doctor's appointment, the patient is interviewed and a physical examination is performed. If there is total hydrothorax, then the following disorders are detected:

• smoothness of intercostal spaces;
• skin cyanosis;
• dullness of percussion sound over the area of ​​transudate accumulation;
• increased breathing rate;
• weakening of breathing.

This syndrome can be determined radiographically. Right-sided hydrothorax is characterized by darkening lung tissue, which can shift when the body position changes. This syndrome can be easily identified during ultrasound examination. To determine the causes of this pathology, tomography is performed.

It allows you to detect neoplasms and enlarged The lymph nodes. To assess the condition of the heart, electrocardiography and ultrasound are required. If right-sided or left-sided hydrothorax is suspected, the following laboratory tests are required:

• are common clinical tests blood and urine;
• biochemical research;
• Rivolta test;
• cytological analysis.

A pleural puncture is more informative. During this procedure, fluid is collected for testing. A smear is prepared from it. To exclude tuberculous etiology of hydrothorax, bacteriological analysis is required. In order to distinguish transudate from exudate, a protein test is performed.

Treatment tactics

Experienced doctors must know the causes of hydrothorax, what it is and how to treat patients. An important aspect therapy is to eliminate the underlying etiological factor. Treatment should be aimed at the underlying disease. If a person has congestive heart failure, then it is necessary:

• follow diet number 10;
• reduce the amount of water consumed;
• take medication;
• change your lifestyle.

Treatment of hydrothorax in this situation involves the use of diuretics, beta-agonists and cardiac glycosides. To reduce the load on the left ventricle of the heart, vasodilators and ACE inhibitors may be prescribed as indicated. If encysted hydrothorax is caused by renal pathology, then it is recommended to remain calm.

Appointed treatment table No. 7. At severe loss proteins, albumin is introduced. Diuretics are used. Kidney disease must be treated with diet. It is recommended to completely avoid salt. Diuresis should be 200-300 ml. If instrumental studies reveal a small volume of transudate, then conservative therapy is sufficient.

At large quantities fluid requires a pleural puncture. This is a therapeutic and diagnostic procedure, during which the transudate is sucked out with a needle. Most often, the puncture is done in the area of ​​the 8th intercostal space. Mandatory local anesthesia Novocaine. With 1 puncture, no more than 1.5 liters of fluid can be removed.

After the procedure, a control is carried out instrumental study. The prognosis depends on the underlying disease. Thus, hydrothorax does not pose a great danger, but its development indicates damage to vital important organs(liver, heart, kidneys). If shortness of breath and other symptoms appear, you should immediately contact a specialist.

Patients with diseases associated with the lungs are interested in what hydrothorax is. Transudate is a liquid that begins to accumulate in the body due to disruption of the circulatory or lymph circulation systems; during its formation, no inflammation occurs; its accumulation in the respiratory organs (pleural area) is called hydrothorax of the lungs. Often this is a complication of existing diseases, and not a separate ailment (for example, cancer, pneumonia). In the case when the episode concerns a pregnant woman, such a problem can arise not only in the mother, but also in the fetus.

Hydrothorax, what is it?

It’s worth starting with the fact that a syndrome such as hydrothorax of the lungs has not only individual symptoms, but also has three forms of manifestation, its classification is as follows:

• Left-sided hydrothorax;
• Right-sided hydrothorax;
• Bilateral hydrothorax.

History of development of this disease rarely recorded damage to only one lung (especially the left). Most often, it happens that one of the organs begins to suffer (on the left or on the right), and then the disease will spread to the partner organ, acquiring a more familiar form of flow (bilateral).

All types have identical signs, diagnostic methods and treatment.

As stated earlier, hydrothorax in the lungs can be caused by dysfunction different systems, both lymph and blood accumulate in them. This is also usually divided into several groups:

• Hemothorax - accumulation of blood;
• Chylothorax - accumulation of lymphatic fluid;

Just as with other diseases, disruption of organ function will not be noticeable until early stages. In this situation, everything depends on the volume of fluid that has managed to accumulate in the lungs; up to the limit of 200 ml, a person usually has no idea about any syndrome. If you don't pay attention to this problem, the total volume of liquid can exceed several liters, which is already very dangerous. If treatment is ignored, hydrothorax can cause many complications, including:

• Heart attack;
• Kidney failure;
• Liver dysfunction;
• Swelling of the respiratory system;
• Hypoxia (respiratory failure);
• Impaired blood circulation.

Usually this disease does not cause mortal danger, if you don’t delay going to the doctor too much, but this is an indication of another, more serious illness.

Causes of hydrothorax of the lungs

What can cause hydrothorax in the lungs? Medicine has not fully explored this phenomenon and doesn't know about everyone possible roots Problems. However, some of them are still discovered and proven; this list includes the following diseases:

1. Renal failure, which accompanies nephrotic syndrome. Hydrothorax of the lungs in this case is provoked by low oncotic pressure;
2. Myxedema is a deficiency of thyroid hormones. Protein metabolism is disrupted, their absorption into digestive tract, and if you eat foods that do not contain it, there will be complications, often leading to dystrophy;
3. Hydrothorax of the lungs in oncology is not so manifested physiological reasons, but rather mechanically. The circulation of lymph and blood is disrupted, which increases blood pressure;
4. Cirrhosis of the liver;
5. Ascites. Pathological accumulation of fluid in the abdominal cavity, which creates excessive pressure and as a result it can leak through the pores into the pleural space, resulting in hydrothorax in the lungs;
6. According to the same scheme, small hydrothorax can be provoked during peritoneal dialysis. This procedure involves entering abdominal cavity a large volume of liquid, and then removing it.
7. For heart failure chronic form(CHF), doctors often detect pulmonary hydrothorax syndrome (hemothorax) of varying severity. Stagnation of blood, which can form in any part of the body, increases hydrostatic pressure and, against the background of this, the fluid passes into the pleural area, this situation in most cases, it is bilateral in nature. The syndrome has the following symptoms:

• Tachycardia;
• Shortness of breath;
• Night toilet, with a smaller volume;
• Attacks of aggression;
• Insomnia;
• Depression;
• General fatigue in daytime days.

In addition to all of the above, the causes of hydrothorax may be as follows:

• Various tumors, edema during pregnancy;
• Pneumonia;
• Ovarian fibroma;
• Physical injuries in the chest area;
• Anemia;
• Pericarditis;
• Amyloidosis.

Hydrothorax of the lungs, symptoms

It is worth immediately highlighting two categories of this disease, which are very different from each other and have different symptoms.

• Small hydrothorax (up to 150 ml of accumulated fluid). It is a kind of complication of the underlying disease, and not an individual disease;
• Total hydrothorax. Such a problem can manifest itself without any precursor diseases;
• encysted;

If we do not take into account the symptoms that are characteristic of a particular disease, then this disease has the following general characteristics:

• Complaints of chest pain;
• Fingers may become swollen;
• Dry cough;
• Swelling of different parts of the body;
• Tachycardia;
• Presence of sleep disorders;
• Shortness of breath;
• Enlarged lymph nodes;
• Muscle pain;
• Forced pose. It expresses the tilt of the body in the direction where more fluid has accumulated;
• Restricted movements;
• In severe cases - deformation of the chest (it protrudes forward);

For the most part, such signs only develop over time as the problem begins to become more serious. Having discovered them, you should consult a doctor, and if he diagnoses you with hydrothorax, treatment should be prescribed in a timely manner in order to avoid unpleasant consequences.

When answering the question: “Hydrothorax, what is it?” It is worth noting that, unlike pleurisy, during its course, this disease is not accompanied by inflammation.

Diagnostics

The examination to determine hydrothorax, what it is and what its etiology is, in each specific case includes a certain number of procedures:

• X-ray. Problem areas on an x-ray appear as a uniform darkening;
• Percussion of the lungs. IN in this case the percussion sound will be dull, and above the upper border of the liquid it will be dull tympanic (similar to the sound of a drum);
• Puncture of the pleural cavity for hydrothorax is performed in mandatory. This is done in order to determine the nature of the fluid that has accumulated in the respiratory organs.

Important! From x-rays there will be no benefit for mild disease, since the amount of blood or lymph is minimal (100-200 ml).

• Ultrasound. Using it, you can determine even the smallest accumulation of fluid (from 10 ml), and also see at what point a pleural puncture will be performed most successfully. Often used in diagnosis during pregnancy;
• CT scan;

In addition, a number of laboratory tests are taken:

• Rivolt's test (distinguishes transudate from inflammatory fluid), in the case of hydrothorax the test is negative;
• Blood analysis;
• General urine collection;
• Cytology;
• Bacteriology;
• Study of material obtained through puncture.

Important! Also found in gynecology this complication- hydrothorax of the fetus during pregnancy. The difficulty is that the mother may not have any symptoms or the disease itself. The syndrome can be caused by similar reasons as in an adult body, but it is much more difficult to detect them, especially if the equipment for research is middle class; in this case, an x-ray will definitely not help. Most often, the root of the disease is the heart. Also, there are situations when, due to Rh conflict, the functioning of the circulatory system is disrupted. If the child is newborn, then such a diagnosis can be made due to a entwined umbilical cord or birth injuries.

Treatment of hydrothorax

How to treat it painful condition? It is important to understand that treatment folk remedies in this case, it may not only have zero effect, but also a huge danger to human health. Help should be provided in a timely manner by the treating specialist.

A this moment exist various ways by removal excess liquid from the human body, however, in the case of the lungs, such operations involve a puncture in the soft tissues:

• Thoracentesis;
• Thoracentesis;
• Drainage of the pleural cavity (Bülau drainage method);
• Puncture with aspiration.

In this way, hydrothorax can only be temporarily alleviated, the treatment of which should first of all involve treatment of the underlying disease. Why don’t doctors perform these procedures for any accumulation of transudate? With each subsequent “pumping”, the concentration of protein in the body decreases, and if it does not have time to recover, this is fraught with complications.

However, despite the characteristics of each disease, there are a number of recommendations that must be followed:

• Normalize your diet. He must exclude salty food, coffee, alcohol, excessive amounts of liquid. A nutritionist can help you balance your diet;
• Avoid stressful situations;
• For heart problems it is prescribed fractional meals(5-6 times a day). The medications used include cardiac glucosides and phosphodiesterase inhibitors (increasing the contractile function of the myocardium). In addition, to remove excess liquid use diuretics;
• Kidney failure can only be cured together with the underlying disease. Also recommended bed rest and diet;

To prevent hydrothorax, various folk recipes diuretics:

1. Pour in 0.5 tsp. chopped parsley 500 ml boiling water for 12 hours and drink 1 tbsp. l. before eating;
2. Birch juice. No more than 2 times a day, 100 ml;
3. Fresh blackberry, black rowan or serviceberry, take 1 tbsp 3 times a day. l.;
4. The following herbs are often used:

• Birch leaves;
• Lingonberry leaves;
• Horsetail;
• Bearberry;
• Orthosiphon.

There are many situations during which hydrothorax of the lungs can occur. For example, when oncological diseases this occurs quite often and brings additional problems and deterioration general condition sick. First aid should be provided by a doctor; if the root cause is treated, then such a complication will go away on its own and will not have time to develop into something more. After therapy, an X-ray examination is prescribed to ensure that the course of treatment was successful and all possible problems were eliminated.