Small hydrothorax bilateral. Hydrothorax (hematorax). Classification, clinic, diagnosis, treatment. Hydrothorax of the lung: causes and forms of the disease

Hydrothorax of the lung- enough serious condition, which is accompanied by a cluster At the same time similar pathology is not a result inflammatory process, but occurs as a result of an increase in the vessels of the circulatory system.

Hydrothorax of the lung: causes and forms of the disease

As already mentioned, the accumulation of fluid in the cavity between the pleural sheets is caused by changes in pressure inside the vessels. But what is the reason for its increase? In fact, hydrothorax of the lungs can be the result of many diseases:

• First of all, it is worth noting heart failure, which is often accompanied by just such complications.
• The causes also include some kidney diseases, in particular amyloidosis and glomerulonephritis.
• Decreased amount of hormones secreted by the thyroid gland.
• Liver cirrhosis often leads to changes in blood oncotic pressure, which, in turn, can cause fluid accumulation.
• Tumor large sizes, located in the mediastinum and compressing large vessels.
• Pronounced deficiency ascorbic acid and some vitamins in the body.
• Disruption of normal lymph outflow.

Hydrothorax of the lung and its symptoms

On initial stages similar condition, as a rule, does not affect the human condition in any way. However, with an increase in the amount of fluid in the pleural cavity, the first symptoms begin to appear. As a rule, patients complain of a feeling of heaviness in the chest. Later, breathing problems appear. The patient increasingly experiences a feeling of lack of air. Therefore, over time, breathing becomes more frequent, but superficial. Hydrothorax of the lungs almost never causes either fever or chest pain. However, when there is accumulation in an organ large quantity liquid one side chest may rise and become more convex. Upon careful examination, you will notice that the affected area lags behind during breathing movements. It is difficult for the patient to lie down or do physical labor - he reflexively tries to take a semi-sitting position, in which it is much easier to breathe.

Hydrothorax of the lung: diagnostic methods

Hydrothorax of the lungs: treatment

In fact, the treatment process directly depends on the cause of the accumulation of transudate in the pleural cavity. For example, when cardiovascular failure requires taking appropriate medications, diet, physical activity and lack of stress. At the same time, in cirrhosis it is indicated not only special food, but also taking hepatoprotectors. In cases where a large amount of fluid has accumulated in the pleural cavity and it strongly compresses the lungs, it is removed during puncture.

Hydrothorax - pathological condition, developing with the accumulation of transudate in the pleural areas. Transudate is an effusion of non-inflammatory origin, the production of which occurs when the hydrostatic pressure in the pleural capillaries exceeds the colloid-osmotic pressure of the plasma, liquid with a low protein content sweats through the capillary wall and accumulates in the pleural cavity.

Hydrothorax is not an independent disease, that is, it certainly develops against the background of another disease. Cause of hydrothorax there is always a chronic or complicated disease of internal organs, by-effect from treatment or its complete inadequacy.

Usually, bilateral hydrothorax develops, less often - right-sided, and extremely rarely - left-sided. Hydrothorax is often combined with accumulation of transudate in abdominal cavity, in the pericardial cavity or with edema subcutaneous tissue. The occurrence of hydrothorax is often asymptomatic, but the gradual accumulation of transudate signals itself as follows: symptoms:

• feeling of heaviness in the chest;
• dyspnea;
• Breathing becomes easier when sitting;
• peripheral edema.

The presence of prerequisites for the development of hydrothorax and a combination of the above listed symptoms is a reason to immediately seek emergency medical help.

How to treat hydrothorax of the lungs?

Treatment of hydrothorax must be carried out under strict medical supervision, and therefore it is advisable to hospitalize the patient. Medical therapy should be aimed not only at eliminating transudate from the pleural cavity, but also at eliminating its causes, that is, treatment of the underlying disease is assumed.

During the examination, the amount of transudate and the causes of its occurrence are determined. If the transudate is characterized by its moderation, then with proper treatment of the underlying disease, it resolves on its own. If its quantity leads to pronounced functional disorders, the patient is prescribed a puncture with aspiration of fluid from the pleural cavity in one or two doses.

It is extremely important to take advantage of all opportunities conservative treatment underlying disease, since frequent transudate punctures lead to significant loss of protein and provoke a certain predetermination of surgical procedures. In other words, the lack of adequate treatment for the underlying disease leads to frequent cases of hydrothorax and forced measures to treat it.

What diseases can it be associated with?

• Decompensated

Treatment of pulmonary hydrothorax at home

Suspicion of hydrothorax is a reason to hospitalize the patient and conduct a detailed examination. Detection of a sound with a tympanic tinge during percussion, weakening of breathing or its absence at all in the area of ​​dullness, displacement of the borders of the heart in the direction opposite to the accumulation of transudate indicates hydrothorax. An x-ray examination is prescribed, where there will be a noticeable darkening in lower parts pulmonary fields.

The patient is urgently hospitalized and, if there is a large accumulation of fluid in the pleural cavity, a diagnostic puncture is performed. Unloading pleural punctures are performed in a hospital setting, in parallel with which treatment of the disease preceding hydrothorax is carried out.

The rehabilitation period is best spent under the supervision of doctors in a hospital setting or at least an outpatient clinic. Self-medication is dangerous not only for health, but also for the life of the patient.

What drugs are used to treat hydrothorax of the lungs?

Conservative therapy hydrothorax involves the use of drugs to treat the underlying disease and means to remove fluid from the body. At the same time, dehydration and complete leaching of protein from the body must not be allowed. The drugs must be prescribed by the attending physician.

Treatment of hydrothorax of the lungs with traditional methods

Treatment of hydrothorax folk remedies are not a panacea and should certainly be discussed with your doctor. Self-resorption of transudate from the pleural cavity is facilitated by treatment of the underlying disease, as well as taking medications that help remove fluid from the body. To diuretics folk remedies include:

• parsley decoction with milk- pour half a kilogram of parsley with unpasteurized milk and place either on low heat or in the oven; simmer until the broth has reduced by half, but do not boil; take 1-2 tbsp;
• turnip peel decoction- Place 1 cup of turnip peel in a saucepan, pour 3 liters of boiling water, close tightly and simmer in the oven for two hours; take one glass per day;
• onion juice- finely chop two onions, add a small amount of sugar overnight, squeeze out the juice in the morning and take 2 tbsp daily on an empty stomach.

Maybe traditional treatment and underlying diseases, which again needs to be discussed with your doctor.

Treatment of pulmonary hydrothorax during pregnancy

Treatment of hydrothorax in a pregnant woman should be strictly monitored medical personnel. Since hydrothorax develops as a consequence of dangerous and complicated diseases, it is not so much dangerous for the pregnancy itself as the underlying disease that needs treatment. You should consult your doctor about the need and possibility of continuing pregnancy, but the condition of hydrothorax itself requires urgent treatment, the benefit of which for the mother always exceeds the danger to the fetus.

Which doctors should you contact if you have hydrothorax of the lungs?

Treatment of other diseases starting with the letter - g

Hydrothorax of the lungs is a pathology in which fluid accumulates in the pleural cavity. In most cases, this process occurs without significant inflammation. Hydrothorax cannot be considered independent disease, most often this condition occurs as a complication of the underlying disease. Stagnation of fluid in the lungs can become a companion to pathologies in which there is stagnation of blood in the pulmonary circulation, as well as those that occur with strong increase pressure.

Classification of the disease

Hydrothorax of the lungs is chest dropsy, which is what people call this disease. Pathology can occur in three forms:

• Right-sided hydrothorax is a fairly rare type of disease.
• Left-sided hydrothorax is a less common form.
• Bilateral hydrothorax is the most common type of disease.

Often, unilateral hydrothorax develops first, which then becomes a bilateral process.

Chest dropsy is also divided according to another principle:

• Ordinary hydrothorax.
• Chylothorax is a pathology when lymph collects in the pleura.
• Hemothorax - with this form of the disease, blood accumulates in the pleura.

In addition, there may be total and encysted hydrothorax. Latest form the disease is as rare as left-sided dropsy.

The volume of fluid that accumulates in the pleura may vary. These figures range from 100 ml to 2-3 liters. Usually, the symptoms of the disease hardly bother a person if the volume of liquid does not exceed 200 ml.

With dropsy, the lung tissue contracts and decreases in size.. This is especially pronounced when the volume of liquid is too large. May move internal organs adjacent to the pleura. The result of this process is respiratory failure and impaired blood circulation; leaving this condition without treatment is very dangerous.

Hydrothorax can lead to a heart attack, provoke serious illnesses kidneys and liver, and also result in pulmonary edema and other life-threatening conditions.

Causes of the disease

Hydrothorax is a consequence various diseases which occur with a strong increase in blood pressure. The main causes of this pathology are:

• tumors localized in the chest;
• cirrhosis of the liver;
• chronic heart diseases, including defects, both congenital and acquired;
• anemia;
• chronic kidney disease, as well as acute conditions which are accompanied by fluid retention in the body;
• malabsorption syndrome;
• sternum injuries;
• myxedema.

Various kidney diseases often lead to a decrease in blood plasma pressure, which in turn contributes to the development of hydrothorax. Similarly, the disease develops when nutritional dystrophy. In liver cirrhosis, the disease occurs due to fluid entering the pleural cavity from the peritoneum. Tumors different types become predisposing factors to the development of the disease, while the outflow of lymph and blood is greatly impaired.

A predisposing factor is a metabolic disorder in the body.

Symptoms of the disease

The severity of the symptoms of the disease depends on the type of hydrothorax and location. If a lot of fluid has accumulated in the pleural area, the patient is bothered by shortness of breath and a feeling of heaviness in the chest. Moreover, discomfort is observed from the affected part of the organ. If the dropsy is located on the side of the right lung, then the pain is felt on the right; if the left lung is affected, on the left; with bilateral dropsy, there is a feeling of pressure in the entire chest.

Hydrothorax usually develops gradually. This period can vary from several days to several weeks. Most often, fluid accumulation is observed over several days. As the volume of fluid in the pleural area increases, the disease manifests itself with the following clinical picture:

• A person experiences a feeling of severe heaviness in the chest. Discomfort decreases somewhat when the patient lies on the side of the affected organ. If the volume of fluid is significant, the patient tries to take a semi-sitting position. With this position of the body, the fluid moves to the underlying part of the pleural cavity and no longer puts pressure on the lungs or does not press so hard.
• The patient has a feeling that when breathing, the lungs are not filled with enough oxygen.
• The person begins to breathe frequently and deeply, but even this does not save him from feeling constant shortage air.
• A little later you can see cyanosis skin, which indicates chronic respiratory failure. In this case, the ventilation of the lungs is severely impaired and an excess amount of carbon dioxide appears in the blood.
• Body temperature remains normal or even decreases slightly, relatively normal indicators. This is explained by the fact that dropsy is not an inflammatory process.

If too much fluid has accumulated in the lungs, it limits the mobility of the sternum.. You can observe a lag on the affected side in the respiratory act. This leads to the fact that the spaces of soft tissue between the ribs become smoothed out, and then even bulge, which can be detected during a thorough examination of the patient.

Often hydrothorax of the lungs occurs simultaneously with hydropericardium and ascites. In this case, in addition to changes in the respiratory organs, additional symptoms will be observed:

• Abnormal fatigue, gradually increasing shortness of breath, cardiac dysfunction, which is noticeable from the ECG results.
• Feeling constant pressure and distension in the abdomen, ongoing nausea, sometimes developing into profuse vomiting. In addition, there may be a protrusion of the peritoneum in the navel area, as well as swelling and changes in shape abdominal wall. If the patient lies down, the abdomen seems to spread out and become flat; in a sitting position, the peritoneum hangs down.

There are cases when hydrothorax, although it appears first, is less pronounced than the same hydropericardium and ascites. Correct diagnosis can only deliver experienced doctor based on examination of the patient and various tests.

With thoracic hydrops, the quality of life is greatly impaired. At strong accumulation liquid, the patient has difficulty walking, sleep is disturbed and this is accompanied by irritability.

Diagnostics

With small hydrothorax, when the volume of fluid in the lungs does not exceed 150 ml, no specific treatment not required. In this case, the complication of the underlying illness may go unnoticed, especially if the patient is an obese person, for whom slight heaviness in the chest and shortness of breath are completely normal.

When an x-ray is taken, the dropsy appears as a darkened area on the x-ray. This area can change its position, depending on what position the patient has taken. To correctly make a diagnosis or confirm it visually, the following research methods are used:

• Do X-ray, which clearly shows the presence of fluid in the lungs.
• An ultrasound is performed. This method allows you to determine not only the localization of the process, but also the total volume of liquid.
• Appointed CT scan. This type of examination often allows you to determine the root cause of the disease.

It should be taken into account that hydrothorax of the lungs in oncology is always one-sided and affects a limited area of ​​the pleural space.

The patient must undergo blood and urine tests. In addition, a puncture is taken from the pleural cavity, the liquid of which is then sent to the laboratory. This is necessary in order to exclude pleurisy of an inflammatory or infectious nature.

The patient may be prescribed a series additional examinations in the event that the disease that caused dropsy was not previously diagnosed and treatment was not carried out.

Treatment

If the dropsy is small in volume, treatment is aimed at eliminating the underlying disease. To treat such cases, cardiac and diuretic drugs, as well as vitamin complexes, can be prescribed.

Aspiration

If a lot of fluid has collected in the pleural cavity and this manifests itself various symptoms, the patient is prescribed a puncture with further aspiration of fluid. This manipulation is aimed at slowly removing pathological fluid from the lungs. The procedure is carried out using a long and fairly thick needle. The resulting liquid is always sent for analysis. To rule out other lung diseases.

The fluid aspiration procedure is performed with the patient sitting. Before manipulation in bottom part pleura give an anesthetic injection. No more than one and a half liters of liquid can be pumped out in one procedure. IN otherwise organs may shift and become very low arterial pressure. After the procedure, the puncture site is lubricated antiseptic ointment and covered with a sterile bandage.

After cleansing the pleura from excess liquid blood circulation in the lungs and breathing are normalized. This operation is considered simple and therefore does not require special preparation.

Sometimes the puncture can be performed several times, in such a case We are talking about recurrent hydrothorax.

Eliminating the root cause

Although puncture is considered a simple operation, doctors do not always resort to it. Most often they try to limit themselves to drug treatment. With frequent aspiration of fluid from the lungs, the body loses a lot of protein, which leads to severe metabolic disorders.

If chest dropsy occurs as a complication of liver cirrhosis, then the patient is prescribed a strict diet, with a limited amount of salt and water. At the same time, the amount of protein in the diet should be increased. Diuretics may be prescribed according to indications.

When the disease is a complication of kidney disease, the patient is advised bed rest. It is in this position that the outflow of urine from the body improves. Salt can be completely excluded from the diet or its volume can be greatly reduced; if edema is present, it is necessary to monitor the amount of water drunk per day. A number of medications are prescribed, which are selected by the doctor individually.

If the problem is heart failure, then the patient is advised to adhere to special diet, eat small meals, get enough rest and avoid stress. The doctor prescribes heart and diuretic drugs.

The patient may be referred for consultation to specialists if hydrothorax is caused by diseases important organs and systems.

Complications

The most common complication is acute respiratory failure. This condition develops due to the fact that fluid compresses the lung tissue, and the useful volume of the lungs is significantly reduced. In this state, air circulation in the damaged respiratory organ is broken, which manifests itself characteristic symptoms– chest pain and shortness of breath.

If an infection is associated with dropsy, it may occur purulent lesion pleural sheets. This pathology is called pleural empyema.

If hydrothorax is complicated bacterial infection, antibiotics are always added to treatment wide range actions.

To avoid hydrothorax of the lungs, it is enough to promptly treat diseases that can provoke dropsy. In addition, you need to protect the chest from various injuries.

Normally, the pleural cavity contains a small volume of fluid (0.26 ml/kg), which acts as a lubricant and reduces friction between the pleural layers.

An increase in the amount of fluid indicates the presence of fluid, which is characteristic of a number of diseases of a pulmonary and extrapulmonary nature. When carrying out diagnostics, the volume of effusion and its nature are taken into account. We speak of minor hydrothorax when the accumulated fluid is non-inflammatory in nature and its amount does not exceed 150 ml.

Causes of minor hydrothorax

Normally, the possibility of reabsorption of fluid produced in the pleural cavity significantly exceeds its production. The accumulation of effusion occurs due to a significant increase in its production or blockage of the reabsorption process.

The pleural cavities do not communicate with each other. Therefore, with a bilateral process, the causes of transudate accumulation are usually associated with extrapulmonary diseases.

• Cardiovascular failure due to decompensation of heart disease, coronary disease, arterial hypertension, myocarditis. The accumulation of transudate is caused by an increase in hydrostatic pressure.

• Kidney diseases, in particular glomerulonephritis with nephrotic syndrome, amyloidosis. At the same time, the content of blood albumin decreases and oncotic pressure drops.
• Myxedema and oncological diseases.
• Pleural effusion occurs due to low amounts of proteins in the blood.
• Ascites and peritoneal dialysis lead to leakage of effusion through the pores and defects of the diaphragm.
• In liver cirrhosis, two factors are important: a violation of protein synthesis, causing a decrease in colloid osmotic pressure of the blood, and the penetration of ascitic fluid through the diaphragm.
• Nephrosis in collagenosis ( rheumatoid arthritis, systemic lupus erythematosus).
• Embolism pulmonary artery, .
• Lung cancer, mediastinal tumors.

• Meigs syndrome – ovarian tumor complicated by ascites and hydrothorax;
• effusion due to medication;
• malabsorption syndrome, nutritional dystrophy;
• “yellow nails” syndrome – congenital pathology lymphatic system;
• superovulation as a result of the action of gonadotropins;
• chronic hemodialysis;
• Dressler syndrome;
• contact with asbestos;
• pancreatic effusion associated with pancreatic pathology;
• formation of transudate in the pleural cavity after surgical interventions, on the heart, esophagus, abdominal organs.

Video

Video - Air and fluid in the chest cavity

Types of effusions with hydrothorax

Depending on the cause of development and the clinical situation, pleural effusion acquires certain features.

Hydrothorax can be classified as one of the following types:

• small, large or total;
• one-sided (right or left), two-sided;
• associated with the accumulation of fluid in other cavities ( abdominal, pericardial) or
• total swelling of soft tissues (anasarca);
• encysted, when the accumulated fluid is separated from other parts of the pleural cavity by adhesions.

Symptoms of hydrothorax

The clinical picture of hydrothorax is determined by the nature of the disease that led to the accumulation of fluid.

Actually, the presence of effusion will be indicated by the following complaints:

• Shortness of breath that occurs during physical activity.
• Feeling of heaviness in the lower parts of the chest.
• Acrocyanosis is a bluish discoloration in areas of the body remote from the heart.
• Lag in breathing of half the chest with a right or left-sided process.
• A two-way process will be much more difficult to determine in this way.
• Relief of the condition in the lateral lying position corresponding to the side of the lesion.

Most often, bilateral accumulation of transudate is observed. Right localization process can also be found quite often. Isolated - quite rare.

With a small volume of fluid in the pleural cavity, the symptoms of hydrothorax will be mild. The volume of transudate is small and does not cause significant deterioration in respiratory function or compression lung tissue and mediastinal organs. Often the symptoms of the underlying disease come to the fore, and hydrothorax is identified during comprehensive survey patient.

An objective examination reveals the following signs of pathology:

• The weakening of vocal tremors over the area of ​​transudate accumulation is determined by palpation. To do this, evaluate changes in sound conduction in different areas chest when the patient pronounces phrases.
• Dullness of percussion sound when tapping the chest with fingers. If the volume of transudate is large enough, it is possible to determine the line corresponding to the upper limit of the effusion. The fluid level shifts when the patient's body position changes.
• Breathing sounds in the area of ​​the effusion are weakened or cannot be heard.

With encysted option pleural effusion encountered in situations where the patient previously suffered pleurisy, as a result of which interpleural adhesions formed.

The accumulation of transudate - edematous fluid - in the pleural cavity is most often observed in cases of circulatory or lymphatic drainage disorders.

It is possible to distinguish transudate from exudate, which is characteristic of processes of an inflammatory nature, through laboratory examination of biomaterial obtained during pleural puncture.

Differential diagnosis should be carried out with hemothorax and chylothorax, when blood or lymph with an abundance of fat accumulates in the pleural cavity. But a small amount of fluid may make puncture impractical. Therefore, in such situations, the nature of the effusion is judged indirectly by clinical picture diseases and data from other diagnostic studies.

Diagnosis of small pleural effusion

Availability of complaints and pathological symptoms, identified during examination and physical examination, serves as a reason for further research.

For precise setting diagnosis using general clinical methods, instrumental and laboratory methods for determining the characteristics of effusion:

• general blood test, urine test, biochemical analysis blood, ECG;
• sputum analysis for atypical cells and Mycobacterium tuberculosis;

• diagnostic pleural puncture with determination leukocyte formula, protein, glucose, specific gravity, bacterioscopy, identification atypical cells, pathogens of tuberculosis;
• X-ray examination reveals a large volume of effusion, small amounts of fluid are better
• are detected on the image in the supine position;
• Ultrasound scanning of the pleural cavity allows you to determine the amount of effusion, suggest its nature, and detect intrapleural adhesions;
• Computed tomography is the most informative examination, providing the opportunity not only to study the characteristics of the effusion, but also to assess the condition of the lung tissue, pleura, and mediastinal organs.

Transudate is characterized by relatively low level squirrel, negative test Rivalty. This test detects the presence of seromucin globulin, which is not typical for non-inflammatory effusions. Small effusions are often not detected on a chest x-ray. An ultrasound or computed tomography will be more informative.

To clarify the cause of the pathology, an in-depth study of the heart, kidneys, liver, thyroid gland and other organs. Performed according to indications functional tests, ultrasound or tomographic scanning, others are used diagnostic methods. An isotope scan of the lungs, intradermal tests with tuberculin, serological tests for rheumatoid factors.

Treatment methods for minor hydrothorax

The primary task in pathology with a small volume of transudate is etiopathogenetic treatment. It includes methods of influencing the causes and mechanisms of the disease that caused the appearance of pleural effusion.

Fluid evacuation for small amounts of effusion is rarely required. If the lesion is bilateral, the problem is caused by systemic disorders. Removing the fluid will not have any effect, since the effusion will form again. Elimination of the cause of transudate accumulation often leads to spontaneous resolution of pleural effusion:

Heart failure requires the following measures:

• prescribing a diet with limited fluid and salt;
• mode correction depending on the condition;
• administration of drugs to improve myocardial contractility ( cardiac glycosides);
• appointments medicines to remove excess fluid from the body (diuretics);
• therapy that reduces the load on the heart ( ACE inhibitors, peripheral vasodilators).

• maintain bed rest;
• a diet with strict restriction of salt, liquid, and a slight reduction in the amount of proteins;
• correction of protein metabolism disorders in the form of prescribing drugs that reduce their loss in urine (ACE inhibitors), administration of albumin solution;
• diuretic therapy.

• salt and fluid restriction;
• stepwise diuretic therapy;
• surgical treatment methods.

Therapeutic measures in the presence of effusion, regardless of whether it is unilateral or bilateral, are selected strictly individually. It also depends on a variety of reasons, causing pathology, and on the severity of the condition, the presence accompanying pathologies, from the functioning of the immune system.

If you find an error, please highlight a piece of text and click Ctrl+Enter. We will correct the mistake, and you will receive + to karma :)

Diseases of the chest organs can impair respiratory function lungs. Thus, total is characterized by the accumulation of a large amount of fluid in the pleural cavity, which leads to hypoxia and other disorders. It could be independent disease or complication of other pathological conditions. Most often, hydrothorax on the right or left occurs due to cancer and dysfunction of the heart.

Basic information about the disease

Right-sided hydrothorax is a pathological condition in which fluid of non-inflammatory origin accumulates in the pleural cavity. Swelling of the pleura causes breathing problems, hypoxia and other complications. Usually the disease occurs with metabolic disorders and malignant neoplasms of the chest, but in rare cases it is diagnosed idiopathic form hydrothorax.

Sometimes right-sided hydrothorax is classified as a type of pleural effusion. In essence, the manifestations of this disease are similar to the accumulation of blood in the pleural cavity (hemothorax), exudative inflammation pleura and impaired lymphatic drainage in the mediastinum. The main difference is related to the origin of the pathology: with hydrothorax, transudate accumulates in the pleural cavity, not associated with inflammation or infection.

Left- or right-sided hydrothorax is often diagnosed along with other manifestations of heart, kidney and liver diseases. In addition to the accumulation of fluid in the pleura, patients experience swelling lower limbs, and symptoms of organ failure. In this case, the root cause of swelling of the pleural cavity can be much more dangerous than hydrothorax itself.

Anatomical features

The pleura is a kind of connective tissue “sac” that isolates the lungs from other organs of the chest. In this case, the parietal layer of the pleura lines the inner surface of the chest, and visceral pleura tightly adheres to the lung tissue, bronchi and related vessels. The space between the two layers of pleura is called the pleural cavity. Normally this cavity contains a small amount of serous fluid, facilitating friction of the lungs during breathing.

Main functions of the pleura:

• Maintaining the tightness of the pleural cavity, which is a necessary condition lung function. Thanks to low pressure In the pleural cavity, the lungs expand during inhalation.
• Protection of lung tissue from friction.
• Discharge of serous fluid.

A constant volume of fluid is maintained in the pleural cavity, approximately equal to 10 milliliters. This amount of serous fluid is enough to reduce friction and protect the lungs. Internal mechanism reverse outflow prevents the accumulation of large volumes of fluid. However, under pathological conditions, edema of the pleural cavity may occur. The more fluid accumulates, the greater the impairment of lung function.

Right-sided hydrothorax is less common than bilateral pleural edema, since the main causes of the disease are associated with dysfunction of the heart, kidneys or liver. In rare cases, left-sided hydrothorax is also diagnosed, which can occur due to injury or cancer in the left lung.

Causes

The non-inflammatory origin of the fluid excludes other inflammatory processes, but without data laboratory diagnostics Doctors focus on the patient’s symptoms. With hydrothorax, patients usually show signs of heart, lung, liver and kidney disease.

Main causes and risk factors:

• Kidney failure or other organ disease that causes protein to be excreted in the urine. The gradual development of hypoalbuminemia disrupts blood flow and causes tissue swelling. The same mechanism occurs in nutritional dystrophy.
• Congestive heart failure. In this case, the ineffective work of the heart causes the deposition of blood in the venous section. Due to an increase in hydrostatic blood pressure, right-sided hydrothorax occurs.
• Impaired lymphatic drainage from the chest organs.
• Swelling of the abdominal cavity (ascites), accompanied by a sharp increase in intra-abdominal pressure. Through the diaphragm, fluid from the abdominal cavity can move into the pleura.
• Liver diseases that cause dysfunction of the organ. A lack of albumin protein in the blood is a common complication of liver cirrhosis. The further mechanism of development of pleural cavity edema is similar to kidney diseases.
• Complications malignant neoplasms mediastinal organs.
• Blockage of the pulmonary artery is a pathological condition accompanied by hemodynamic disturbances.

Accurate determination of the cause of swelling of the pleural cavity is important for prescribing treatment.

Symptoms

Left-sided or right-sided hydrothorax may be characterized by different symptoms. The disease differs from pleurisy, in which fluid also accumulates in the pleural cavity, by the absence of an infectious or inflammatory process. The severity of symptoms depends on the volume of fluid. Minor swelling (up to 200 ml) may be asymptomatic.

Possible signs of the disease:

• Progressive shortness of breath that occurs with the gradual accumulation of fluid in the pleura.
• Pain while inhaling.
• Shallow breathing due to pressure in the pleural cavity.
• Paleness of the skin.
• Dizziness.

Some patients do not immediately pay attention to the signs of the disease due to the presence of other lung pathologies that cause respiratory failure.

Diagnostic methods

If you notice symptoms of hydrothorax, you should consult a doctor general practice or a pulmonologist. During the appointment, the doctor will ask the patient about complaints, review medical history and conduct a physical examination. Often hydrothorax on the left or right is discovered during the examination of patients with diseases of cardio-vascular system and kidneys who consulted a doctor due to worsening symptoms. When auscultating (listening) to the lungs, unusual noises are detected. For staging final diagnosis instrumental and laboratory diagnostic data are required.

Special examination methods:

• – the main method of examination. The doctor removes fluid from the pleura for laboratory diagnostics. Hydrothorax is characterized by the absence of signs of infection or inflammation in the specimen.
• Blood test to evaluate kidney, heart and liver function.
• Electrocardiography - research electrical activity hearts. To perform this test, the doctor places special electrodes on the patient's body. ECG results may indicate the root cause of pleural edema.
• Echocardiography – ultrasound examination hearts. During the examination, the doctor can observe the work of the heart on a monitor. Echocardiography is also prescribed to look for primary heart disease.
• Chest X-ray - method primary diagnosis, with the help of which the accumulation of fluid in the pleural cavity is detected.
• Computed tomography and magnetic resonance imaging are high-precision scanning methods necessary for diagnosing primary diseases of the chest organs.
• Endoscopic examination of the chest organs to detect the causes of hydrothorax.
• Biopsy of the pleura and lung tissue, followed by histological examination of the tissue sample. A biopsy is used to diagnose cancers that impair the drainage of lymph in the chest.

Doctors do not need to prescribe all of the listed procedures, but to perform accurate diagnosis it is important to get pictures and carry out laboratory test liquids.

Treatment

The main goal is treatment primary disease which caused swelling of the pleural cavity. At serious illnesses heart, kidney and liver transplantation may be required, but in most cases drug treatment enough to eliminate complications.

The main method of relieving the symptoms of hydrothorax is thoracentesis or pleural puncture. This procedure is performed not only for diagnosis, but also to facilitate breathing in patients with severe pleural edema.

Stages of puncture:

• Obtaining X-ray diagnostic data to determine the puncture site.
• Treating the skin at the puncture site with an antiseptic.
• Tissue anesthesia local anesthetic(novocaine, lidocaine or other drug).
• Inserting a needle into the intercostal area along the scapular or posterior axillary line. Penetration into the pleural cavity is accompanied by the appearance of bubbles in the syringe.
• Slow removal of liquid. Carrying out a puncture too quickly can cause respiratory failure or cardiac dysfunction.
• Removing the needle and re-treating the puncture site with an antiseptic.
• Applying a sterile dressing.

The puncture can be performed in case of emergency or planned treatment. As a rule, this procedure completely relieves the patient of the symptoms of the disease.

Thus, left or right hydrothorax can occur as a complication of oncological and functional diseases. It is important to contact a pulmonologist in time if symptoms of this pathology occur.