Hydrothorax of the lungs: causes, symptoms and treatment. Hydrothorax: radiological signs, types and treatment

Hydrothorax of the lungs- a pathological condition caused by the accumulation of serous fluid in the pleural cavities. This entails a violation of gas exchange in the respiratory organs and, as a result, cyanosis and severe suffocation. Pathology is not considered a separate disease, it is a complication that has arisen against the background of the underlying disease. According to medical statistics, hydrothorax of the left lung occurs least often, right-sided hydrothorax is somewhat more common, and, finally, most often doctors state the development of bilateral hydrothorax of the lungs. Moreover, the patient may first experience a right-sided or left-sided hydrothorax, which subsequently becomes bilateral.

Causes of hydrothorax of the lungs

Hydrothorax of the lungs, as a rule, accompanies diseases that are characterized by stagnation of blood in the pulmonary circulation and hypertension. These are diseases such as:

(both congenital and acquired);
cirrhosis of the liver;
severe renal impairment;
severe anemia;
chest trauma;
pneumonia;

Often, hydrothorax of the lungs occurs with oncology. The most common edematous complication of the lungs in malignant tumors that affect the lung itself, the mammary gland or ovary. Less commonly, hydrothorax is formed with cancer of the gastrointestinal tract, melanoma and pleural mesothelioma.

Treatment of hydrothorax of the lungs

Therapy of hydrothorax of the lungs, as a rule, is carried out in a hospital, so that constant medical monitoring of the patient's condition is ensured. Treatment is carried out in two directions:

Elimination of the cause that caused the accumulation of transudate in the pleural region, i.e. treatment of the underlying disease.
Elimination of pulmonary edema.

In small amounts, transudate can be absorbed in the body without outside help. With pronounced functional disorders, a puncture is performed with aspiration of fluid from the area of its accumulation. The procedure can be carried out in one or two doses with a maximum total pumping out of 1.5 liters of fluid.

Experts are convinced that all the possibilities of conservative therapy should be used, since frequent punctures can cause a decrease in the amount of protein in the body, thereby worsening the patient's condition.

Treatment of hydrothorax of the lungs with folk remedies

To help self-resorption of the transudate and the removal of fluid can be traditional medicine. Here are the most effective recipes.

onion juice

Ingredients:

medium-sized bulb - 2 pcs.;
sugar - 2 teaspoons.

Cooking

Finely chop the onions. Sprinkle chopped onion with sugar and leave overnight. Squeeze out the juice in the morning.

Take on an empty stomach 2 tablespoons.

Turnip peel decoction

Ingredients:

turnip peel - 1 cup;
water - 3 l.

Cooking

Boil water, pour it over the turnip peel, placed in a saucepan. Put the saucepan with turnip peelings in the oven and simmer for 2 hours.

Take a decoction of 1 glass a day.

Parsley with milk

Ingredients:

fresh milk;
parsley - 0.5 kg.

Cooking

Wash parsley thoroughly and finely chop. Put the chopped greens in a saucepan and pour milk so that the parsley is completely covered with it. Put the dishes with parsley and milk in the oven, heat at a low temperature until the liquid has evaporated by half, and strain.

Take the infusion should be 1-2 tablespoons every hour.

Parsley-based tincture also has a diuretic and anti-inflammatory effect, which is not difficult to prepare.

parsley tincture

Hydrothorax of the lung is a pathology characterized by the accumulation of fluid in the pleural cavity. In connection with this feature, the people call this condition thoracic dropsy. Hydrothorax cannot be called an independent disease; rather, it can be characterized as a concomitant condition that occurs with other diseases. In this regard, there are certain rules and principles of treatment. It will not be possible to predict the course of therapy and its consequences in advance, since treatment is prescribed individually in each case.

The essence of pathology

When considering hydrothorax of the lung, one cannot but pay attention to the study of the very essence of this condition. There are three special serous sacs in the human chest, which are designed for each lung individually and for the heart. The pulmonary membrane consists of two layers at once and is called the pleura. The two separate layers are the visceral and parietal pleura. A small slit-like gap between them is called the pleural cavity. In a healthy person, this gap is extremely small and contains 1-2 ml of pleural fluid.

Under certain factors, the amount of fluid in the pleural cavity increases dramatically and can reach 1-2 liters. It is this condition that is called hydrothorax of the lung. However, the penetration of other fluids is also possible, in connection with this, the names also change: with the accumulation of blood - hemothorax, lymph - chylothorax, air - pneumothorax.

A characteristic feature of this process is the absence of an inflammatory nature.

Features of the appearance of fluid in the pleural cavity

The accumulation of fluid (transudate) in the pleural cavity occurs if the pressure inside the pleural capillaries increases to such an extent that it exceeds the colloid osmotic plasma pressure. Such conditions cause large amounts of plasma to leak out through the walls of the capillaries. It accumulates in the pleural cavity. The code for hydrothorax of the lung according to the ICD is J94.

An increase in the volume of fluid occurs due to a decrease in the volume of the lung, as a result of which the volume involved in breathing is reduced, and a displacement of the internal organs develops.

Localization

This pathological process can occur in several forms, the distinguishing feature is its localization:

right hand;
left-sided hydrothorax of the lung;
bilateral.

The most common is bilateral hydrothorax. This phenomenon can be explained by the following fact. The presence of an underlying disease causes the accumulation of pleural fluid first in one lung (right or left). The absence of pronounced symptoms most often means the absence of correct treatment, which means that over time a similar process develops in the second lung.

What diseases cause hydrothorax

In medicine, several diseases are described at once, which may be accompanied by the accumulation of pleural fluid in the lung. In this case, the main reason is a sharp increase in blood pressure.

Cirrhosis of the liver. According to medical statistics, in 80% of such cases it is the right-sided hydrothorax of the lung that develops.
Tumors located in the organs and tissues of the chest.
Chronic diseases of the cardiovascular system or congenital heart defects. The list of such pathologies includes chronic heart failure (known by the abbreviation CHF). With such indicators, blood stagnation occurs in various parts of the body, provoking hydrostatic pressure. The result of such changes in the body is often the transition of fluid into the pleural region.
Kidney diseases of a chronic nature (the risk is especially high for those people who suffer from a delay in the removal of fluid from the body). The accumulation of fluid in this case is explained by a reduced level of oncotic pressure.
Various mechanical damage, trauma to the sternum.
Malabsorption Syndrome.
Myxedema.
Pneumonia.
Anemia.
Amyloidosis.
Fibroids of the ovaries.

Varieties of hydrothorax

In addition to localization, cases of hydrothorax may differ in the amount of transudate. There are several options:

small - this pathology is characterized by a small volume of fluid (up to 150 ml);
total - characterized by a high content of accumulated fluid;
bagged.

Depending on the characteristics of the pathology, the clinical picture will also differ. In general, the symptoms for all types of hydrothorax are quite similar, but their intensity will vary.

First symptoms

The accumulation of fluid in the pleural cavity occurs gradually. This explains the growing nature of the symptoms. The process can take a few days or 2-3 weeks. At the initial stage, a person does not feel pain or discomfort, so going to the hospital usually postpones.

One of the first symptoms is a feeling of heaviness in the chest. In a standing and sitting position, the unpleasant sensation intensifies. The patient's condition can be somewhat alleviated by the lying position and precisely on the side where the hydrothorax of the lung is located.
Frequent shallow breathing. This symptom is explained by a decrease in the working volume of the lung.
Feeling short of breath. The patient seems to be unable to breathe.
Blue tint of the skin. This symptom is a consequence of prolonged oxygen starvation.
The body temperature remains at the usual level or even decreases slightly. This can be explained by the non-inflammatory nature of hydrothorax.

Later symptoms

If no pathology is detected at the initial stage of the process, the amount of transudate in the pleural cavity will increase, and this will increase the symptoms. Appears:

Rapid fatigue during the day, even with a full night's sleep.
Increasing dyspnea. It is observed even at rest.
Feeling of fullness and pressure in the abdomen and sternum.
Frequent bouts of nausea, they quite often end in vomiting.

During the examination of the patient at this stage of hydrothorax of the lung, the doctor may notice the following signs:

the gaps between the ribs become smoother or even bulge;
when breathing, one side of the chest lags behind in movement (this happens if hydrothorax develops only on one side);
protrusion of the peritoneum in the navel, change in shape and swelling of the abdominal wall.

To obtain a more accurate picture of the disease, the doctor during the examination may ask the patient to take different positions of the body. So, when he sits, the peritoneum hangs down, and if the patient lies on his back, the stomach spreads and becomes flat. Especially often this condition causes bilateral hydrothorax of the lungs.

The presence of such symptoms greatly complicates the life of a person, therefore, in addition to all of the above, patients with a similar diagnosis are irritable, suffer from sleep and appetite disorders.

Diagnostics

After contacting the clinic and the initial examination of the patient, the doctor prescribes a number of hardware studies and laboratory tests. It is quite difficult to determine dropsy of the lung only by visual inspection. The reason for this is the symptoms that are characteristic of many diseases. To identify all associated complications, it is necessary to conduct an examination.

Analysis of urine and blood. In laboratory blood tests, an increased content of carbon dioxide is found in it (this feature occurs due to a lack of oxygen in the body).

X-ray. If lung disease is suspected, an x-ray is one of the most effective and reliable diagnostic methods. In the picture, the cavities with liquid will be painted in darker shades.

ultrasound. Ultrasound examination is necessary not only to detect dropsy of the lung, but also to determine its location and size.

CT. With computed tomography, it is possible to establish the cause of the appearance of pathology.

Puncture. This procedure is the removal of a small amount of fluid from the lung for later analysis in the laboratory. In the course of such a study, doctors are able to identify the chemical composition of the substance and the possible presence of atypical cells in it. This analysis is performed in case of suspected hydrothorax of the lungs in oncology.

Basic principles of treatment

The main task of doctors is not to get rid of the transudate, but to eliminate the cause of its appearance, because hydrothorax is only a consequence of the pathological state of the body.

Pumping fluid out of the pleural cavity whenever it appears is not only a useless, but also a dangerous decision. Each subsequent pumping dramatically reduces the amount of protein in the body. If the concentration does not have time to recover, then the patient has serious complications.

The principle of treatment is based on the characteristics of the underlying disease. To pump out the transudate, the following methods are used:

thoracocentesis (thoracocentesis) - an operation during which a puncture of the chest cavity is performed to gain access to the pleural cavity in order to pump out the transudate;
puncture with aspiration;
drainage according to Bulau (the procedure for draining the pleural cavity).

It is strictly forbidden to treat lung hydrothorax with folk remedies. The wrong choice of treatment can result in serious complications for the patient.

Complications with hydrothorax

The most common complication of dropsy of the lungs is acute respiratory failure. It develops due to strong compression of the lung and is accompanied by pronounced pain in the sternum and shortness of breath even at rest.

In some cases, an infection is added to the pathological condition, which entails damage to the pleural sheets (membrane of the lung). This condition is called pleural empyema.

How to treat hydrothorax of the lungs with medicines

Drug treatment is also possible, but it is indicated only in cases where dropsy is small.

If the pathology is associated with heart failure, then patients are often prescribed diuretics to naturally remove the transudate from the body. Among the most common drugs are Indapamide, Diuretin, Diacarb, Mercuzal, Veroshpiron.

To reduce the loss of protein in the urine, an intravenous infusion of protein preparations is connected.

If an infection is detected, the course of treatment for hydrothorax of the lungs must include the use of broad-spectrum antibiotics.

Important aspects of treatment

In the treatment of hydrothorax of the lungs, all doctor's prescriptions must be observed. So, several aspects affect the speed of recovery at once.

Diet control. Nutrition in such a pathology plays an important role. The patient should refuse the following products:

salty food;
fried, fatty and smoked dishes;
alcoholic products;
coffee;
a large amount of liquid.

With complications, it is extremely important to observe bed rest. In this case, the load on the body will be significantly reduced, and recovery will proceed at a rapid pace.

For the same reason, you need to achieve a stable emotional background. Stressful situations and overexertion should be avoided.

Forecast

In general, chest dropsy responds well to treatment, and doctors give an optimistic prognosis. Hydrothorax of the lungs in oncology is a more complicated case, it is important to take into account the degree of spread of the cancerous tumor, the presence or absence of metastases, the age of the patient and his general condition.

However, such indicators are possible only if the pathology was detected in time, and the doctors prescribed the correct treatment.

Doctors warn: to get a lasting effect and prevent re-accumulation of transudate, treatment should not be interrupted immediately after the symptoms have disappeared. The course of therapy must be completed. At the same time, only the attending physician controls the duration of treatment and the dosage of all drugs. Otherwise, hydrothorax of the right lung (or left) leads to an increase in the size of the pathological process and provokes inflammatory diseases.

Given all of the above, we can conclude that this pathology is not as dangerous as it may seem to patients with a similar diagnosis. You can eliminate chest dropsy quite quickly and effectively by treating the underlying disease. The only exceptions are those cases when this condition is caused by oncological processes. In this case, a long and difficult treatment is ahead.

Hydrothorax in medical practice does not represent a specific disease, this pathological condition is always the result of some underlying serious disease. Hydrothorax is a pathological accumulation of fluid of various volumes in the lungs. The presence of fluid in the lungs is a serious and dangerous threat to the health of any person, since against the background of such a condition, gas exchange in the respiratory system is disturbed, which often results in suffocation.

Most often, pulmonary hydrothorax accompanies the following diseases:

anemia in a pronounced character;
cirrhosis of the liver;
heart failure, as well as acquired or congenital heart defects;
inflammatory processes of the respiratory organs;
chest injury;
oncological diseases.

Treatment

It is important to remember that hydrothorax of the lungs must be treated only in a hospital setting. It is necessary to ensure that the patient is under the constant supervision of medical professionals.

The main therapy is aimed at two levels:

Elimination (that is, cure) of the main cause that caused hydrothorax - treatment of the underlying disease;
Elimination of pulmonary edema.

When pulmonary edema is eliminated, fluid is “pumped out” from the lungs. In some cases, hydrothorax, under the influence of certain therapeutic methods, resolves on its own.

To eliminate hydrothorax, it is often used in complex treatment and alternative therapy. But before using even the most reliable and safe methods, you need to get advice and the obligatory approval of the doctor.

Left-sided hydrothorax

According to medical statistics, left-sided hydrothorax is a fairly rare occurrence.

Left hydrothorax means that the accumulation of pathological fluid occurs in the left lung.

Right-sided hydrothorax

This type of pathology is most common in medical practice. Right-sided hydrothorax is explained by the presence of pathological fluid in the right lung.

Bilateral hydrothorax

But bilateral hydrothorax occupies a leading position among patients. With bilateral hydrothorax, the accumulation of pathological fluid occurs immediately in two lungs.

It is important to note that bilateral hydrothorax can be provoked first by the manifestation of left-sided or right-sided hydrothorax.

Hydrothorax in heart failure

Often a provocateur of the appearance of hydrothorax is any pathology that occurs in the cardiac system. Hydrothorax in heart failure requires careful and correct medical intervention.

Hydrothorax of the lungs in oncology

Doctors observe that often hydrothorax can occur due to the presence of a cancerous tumor in the body. At the same time, cancer can progress in completely different internal systems.

In most cases, hydrothorax occurs due to the presence of a malignant formation in the lungs themselves, in the ovaries or in the mammary gland. But with oncology of the digestive tract, a dangerous complication occurs in rare cases. Rare manifestations of hydrothorax include melanoma, as well as pleural mesothelioma.

Hydrothorax - mcb code 10

Lesions of the pleura in the medical classification of diseases are classified under the code J94. Depending on the individual classification, hydrothorax is classified in conjunction with the main figure:

Unspecified pleural lesion - J 94.9;
Hemothorax - J 94.2;
Fibrothorax - J 94.1.

All photos are taken from the free source Yandex Pictures

Hydrothorax is a disease characterized by the accumulation between the sheets of the pulmonary pleura of non-inflammatory fluid (in medicine it is referred to as "transudate"). Hydrothorax never occurs on its own, it is a consequence of a number of other diseases.

You will learn about why and how hydrothorax develops, about the symptoms, principles of diagnosis and treatment of this pathology from our article.

Fundamentals of Physiology and Pathophysiology

The lungs are covered with pleura, which consists of 2 sheets - visceral and parietal. The accumulation between the sheets of non-inflammatory fluid is hydrothorax.

The lungs are covered with a membrane - the pleura, which consists of two sheets - adjacent to the lungs - parietal, and external - visceral. The space formed by these sheets is called the pleural cavity or pleural cavity. It always contains a small amount of pleural fluid. It is needed in order to ensure easy sliding of the sheets relative to each other during breathing, and also performs some other important functions.

Pleural fluid is produced in the apical (apical) part of the parietal (enveloping the lungs) pleura, and a number of physiological mechanisms ensure its circulation through the cavity. These mechanisms are:

the ratio between the colloid osmotic pressure (due to proteins and electrolytes) of the blood plasma and the hydrostatic pressure in the capillaries of the parietal pleura;
biomechanism of respiration (excursion (shift of boundaries during respiration) of the lungs);
viscosity of the pleural fluid.

Violations in any or several mechanisms at once will lead to the accumulation of excess fluid between the pleura. So, hydrothorax develops in the following situations:

with an increase in hydrostatic pressure in the capillaries of the pleura and a decrease in oncotic pressure in the blood plasma;
in cases of violation of the outflow of lymph at any of the levels (most often - with compression of the mediastinum by an aortic aneurysm or a neoplasm);
with increased permeability of the walls of blood vessels;
in case of increased production of aldosterone by the adrenal cortex;
in violation of electrolyte metabolism.

Causes of hydrothorax

As mentioned above, hydrothorax is not an independent pathology, it accompanies and complicates the course of many other diseases, often being a sign of their decompensation. Such diseases are:

with stagnation in the systemic circulation (accompanies decompensated, constrictive (compressive));
pulmonary hypertension of any origin;
liver diseases accompanied by protein deficiency, in particular, with;
hypofunction of the thyroid gland - myxedema;
TELA;
and kidney disease, accompanied by (loss of protein in the urine);
diseases that occur with a decrease in the concentration of protein in the blood (hypoproteinemia);
tumors that compress the capillaries of the lungs;
peritoneal dialysis, ;
deficiency of protein, vitamins B and C, coming from food.

Symptoms and principles of diagnosis

Clinical signs of hydrothorax are always added to the symptoms of the underlying disease.

The onset of the disease is usually gradual - symptoms appear and increase as the volume of fluid in the pleural cavity increases. Its main manifestations are as follows:

(appears or intensifies);
feeling of lack of air;
feeling of heaviness in the chest from the side of the lesion;
cyanosis (bluish skin tone, which occurs due to oxygen deficiency and the accumulation of carbon dioxide in the tissues);
breathing deep, rapid;
with a large amount of transudate - protrusion of the corresponding half of the chest, restriction of its mobility, lagging behind the healthy half in the act of breathing;
smoothing of the intercostal spaces on the affected side.

The patient takes a forced position in bed - lying on his sore side. It relieves his condition, does not cause difficulty in breathing. If there is a lot of fluid in the pleural cavity, the patient is half-sitting.

On palpation (palpation) of the chest, the doctor will detect the absence of voice trembling, on percussion (tapping) - dullness of the sound, and on auscultation (listening) of the lungs - the absence of respiratory noise above the lesion.

More often, fluid accumulates only on one side (on the right), but there are cases of bilateral hydrothorax, as well as its combination with other syndromes of fluid accumulation in the cavities (hydropericardium - in the pericardial sac, ascites - in the abdominal cavity).

If hydrothorax is suspected, the patient will be assigned the following additional diagnostic methods:

(allows you to detect urinary excretion of protein, cylindruria, erythrocyturia, leukocyturia, increased relative density of urine);
(will reveal hypoproteinemia - a reduced level of protein in the blood, an increase in the level of liver enzymes - in case of liver pathology);
(in the position of the patient standing and lying on the affected side); allows you to detect darkening over the area of fluid accumulation and the smoothness of the angle formed by the diaphragm and ribs;
computed tomography (a highly informative research method that allows you to visualize the minimum amount of fluid contained in the pleural cavity, as well as diagnose diseases that caused hydropericardium - tumors, enlarged lymph nodes of the mediastinum, and others);
Ultrasound of the pleural cavity (detects free fluid of at least 100-200 ml in volume);
puncture of the pleural cavity with subsequent examination of its contents (the puncture is carried out at the level of the scapular or posterior axillary line in the VII-VIII intercostal space); a clear liquid with a yellowish tinge, a density below 1.015, a protein level of not more than 30 g per liter, a reduced concentration of blood cells (mainly erythrocytes and leukocytes) - this is a non-inflammatory effusion, or transudate;
bacteriological examination of pleural effusion (in order to exclude tuberculous pleurisy); the liquid is sown on a nutrient medium, placed in a thermostat, and after a while it is estimated which colonies of microorganisms have grown on it.

Complications

Without treatment, hydrothorax leads to the appearance of chronic respiratory failure or aggravates it, if any.
In some cases, when lung tissue is compressed by a large volume of pleural effusion, acute respiratory failure may develop.
In addition, the fluid can become infected - purulent will develop.

Principles of treatment

With a large volume of fluid in the pleural cavity, it is punctured and the effusion is evacuated.

The main thing in the treatment of excess pleural effusion is enhanced therapy of the disease against which it developed. If it is possible to compensate for its course, the fluid from the pleural cavity resolves by itself.

To speed up this process, the patient is prescribed (furosemide, torasemide and others).

In order to compensate for the protein deficiency, infusions of protein preparations are carried out.

If there is a lot of fluid, the patient needs medical treatment. Up to 1.5 liters of effusion is removed at a time, which greatly facilitates the human condition. Aspiration of a larger volume of effusion is undesirable, since it leads to a sharp shift of the mediastinum in the direction from which the effusion was evacuated, and this is often poorly tolerated by patients.

The next day after the puncture, an x-ray of the lungs is performed - in order to monitor the patient's condition, to exclude the development of complications of the puncture (for example,).

Prevention and prognosis

The main preventive measure is the timely complex treatment of diseases that can lead to the accumulation of fluid in the pleural cavity.

The prognosis is also related to the course of the underlying disease: in some cases, the amount of transudate between the pleura can be brought within the normal range, in others, unfortunately, not, or soon the effusion accumulates again.

Which doctor to contact

If hydrothorax is suspected, it is necessary to consult a therapist. He will find out the preliminary cause of the disease and refer the patient to the right specialist. This may be a cardiologist, hepatologist, endocrinologist, rheumatologist, nephrologist or oncologist. Removal of fluid, if necessary, is carried out by pleural puncture in a therapeutic or surgical hospital.

Hydrothorax (thoracic dropsy) is an accumulation of fluid of a non-inflammatory nature and origin (transudate) in the pleural cavities.

Causes of hydrothorax

Hydrothorax can occur with decompensation of heart failure with the development of stagnation in the systemic circulation; in diseases of the kidneys, accompanied by the development of nephrotic syndrome (glomerulnephritis, amyloidosis of the kidneys, and others); with cirrhosis of the liver, with myxedema (a disease caused by insufficient production of thyroid hormones); in the presence of large tumors in the mediastinum (anatomical space in the middle sections of the 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 alimentary dystrophy due to a pronounced lack of vitamins B and C, as well as due to a violation of the outflow of lymph.

Symptoms of hydrothorax

The main manifestations of hydrothorax are due to the dynamic accumulation of fluid in the pleural cavities and its compression of the lungs, as well as the 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 the frequency and depth of respiratory movements. Cyanosis appears and intensifies (bluish coloration of the skin due to the accumulation of carbon dioxide in the blood).

Pain in the chest is not typical. With a significant accumulation of fluid, the protrusion and limitation of the mobility of the corresponding half of the chest and its lagging behind the healthy one in the act of breathing, as well as the smoothness of the intercostal spaces on the diseased side, is determined. In the supine position, it is easier for the patient to be on the sore side, since this does not lead to difficulty in breathing. With very large volumes of fluid, the patient tries to take a semi-sitting position. Body temperature usually does not rise.

Survey

More often, hydrothorax is bilateral and is often accompanied by hydropericardium (accumulation of fluid in the pericardial sac) and ascites (accumulation of fluid in the abdominal cavity).
In the diagnosis of great importance are x-ray examination of the chest, ultrasound (ultrasound) of the pleural cavities and computed tomography (CT) of the chest. Radiologically, hydrothorax is manifested by a uniform darkening, occupying the lowest located sections of the pleural cavity; this darkening is freely shifted with a change in the position of the body. Ultrasound reveals free fluid in the pleural cavity, a more accurate assessment of its volume is possible. With CT, it is possible to detect, in addition to free fluid in the pleural cavity, some 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 is reduced to therapeutic measures and pleural puncture.
Therapeutic measures are aimed at treating the underlying disease that caused the development of hydrothorax.

So, with hydrothorax, due to the presence of heart failure in a patient, the patient is recommended to optimize the regime of work and rest, exclude psycho-emotional stress states, and normalize sleep. Assign diet No. 10 or No. 10a with limited intake of water and salt, and the food itself should be fractional (up to 5-6 times a day with a small amount of food consumed at one meal).

Drug treatment can be aimed at enhancing the reduced contractility of the myocardium (prescribed cardiac glycosides, β-adrenergic stimulants, phophodiesterase 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 the slow removal of transudate from the pleural cavity. This therapeutic manipulation is at the same time diagnostic, since the nature of the fluid obtained and the results of its laboratory examination make it possible to distinguish hydrothorax from exudative pleurisy, hemothorax, and pleural empyema.

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

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 in the opposite direction.

Causes of hemotrax

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

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

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

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

Pathogenesis of hemothorax

The accumulation of blood in the pleural cavity causes compression of the lung on the side of the lesion 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 hemotrax, a clinic of hemorrhagic and cardiopulmonary shock often develops with acute respiratory and heart failure.

Already in the next few hours after the blood enters the pleural cavity, aseptic inflammation of the pleura develops - hemopleurisy, caused by the reaction of the pleural sheets. With hemothorax, edema and moderate leukocyte infiltration of the pleura, swelling and desquamation of mesothelial cells occur. Once in the pleural cavity, the blood first coagulates. However, then soon the process of fibrinolysis sets in, and the blood thins again. This is facilitated by anticoagulant factors contained in the blood itself and pleural fluid, as well as mechanical defibrination of blood due to respiratory excursion of the chest. As the anticoagulation mechanisms are depleted, blood coagulation and the formation of a clotted hemothorax occur. In the case of the addition of microbial infection against the background of hemothorax, pleural empyema can occur quite quickly.

Classification of hemothorax

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

Given the amount of intrapleural bleeding, hemothorax can be:

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

medium - volume up to 1.5 liters, blood level to the lower edge of the IV rib;

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

total - the volume of blood loss is more than 2 liters, radiologically characterized by a total darkening of the pleural cavity on the side of the lesion.

In addition, a limited (usually small in volume) hemothorax is also isolated, in which the outflow of blood accumulates between the pleural adhesions, in an isolated area of the pleural cavity. Taking into account localization, limited hemothorax can be apical, interlobar, paracostal, supradiaphragmatic, paramediastinal.

In the case of ongoing intrapleural bleeding, they speak of an increasing hemothorax, in the event of a cessation of bleeding, they speak of a non-increasing (stable). Complicated types include clotted and infected hemothorax (pyogemothorax). With the simultaneous entry of air and blood into the pleural cavity, they speak of hemopneumothorax.

Symptoms of hemothorax

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

With a hemothorax of medium or large size, respiratory and cardiovascular disorders develop, expressed in varying degrees. Characterized by a sharp pain in the chest, radiating to the shoulder and back when breathing and coughing; general weakness, tachypnea, decreased blood pressure. Even with slight physical exertion, symptoms worsen. 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 of the skin with a cyanotic tint, flies before the eyes, fainting.

Hemothorax associated with rib fractures is usually accompanied by subcutaneous emphysema, soft tissue hematomas, deformity, pathological mobility and crepitus of rib fragments. With hemothorax that occurs with a rupture of the lung parenchyma, hemoptysis may occur.

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

Diagnosis of hemothorax

With hemothorax, the lagging of the affected side of the chest during breathing, dullness of percussion sound above the liquid level, weakening of breathing and voice trembling are determined. X-ray and plain radiography of the lungs revealed collapse of the lung, the presence of a horizontal level of fluid or clots in the pleural cavity, flotation (shift) of the shadow of the mediastinum in a healthy direction.

For diagnostic purposes, a puncture of the pleural cavity is performed: obtaining blood reliably indicates hemothorax. With a banal and clotted hemothorax, they resort to the 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 of the chest, and diagnostic thoracoscopy.

Treatment of hemothorax

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

For therapeutic purposes, for aspiration / evacuation of blood, thoracocentesis 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 of hemothorax includes hemostatic, antiplatelet, symptomatic, immunocorrective, blood transfusion therapy, general antibiotic therapy, oxygen therapy.