Accumulation of fluid in the chest cavity. What is hydrothorax and how is it treated? Hydrothorax of the lungs: treatment

Hydrothorax of the lungs is a pathology associated with excessive accumulation of transudate between the visceral and parietal pleura. It occurs as a result of a number of diseases in which blood stasis is formed, and capillary hydrostatic pressure prevails over colloid osmotic pressure. Normally, the amount of fluid is a few milliliters. With hydrothorax, it sometimes increases to a liter.

Classification

There are 3 types of disease:

Left-sided, when the accumulation of fluid is formed on the left.
Right-sided (right lung affected).
Bilateral.

The last form of this classification is the most common. Double sided form favorable conditions can form both right-sided and left-sided hydrothorax.

Another type of hydrothorax is encysted. Represents pathological condition when the acute process turns into chronic stage. Occurs in connection with encysted pleurisy caused by Koch's wand.

Causes and mechanism of the development of the disease

The peculiarity of hydrothorax is that it is not considered an independent disease, it is considered only as a complication that occurs against the background of other pathologies, not necessarily pulmonary.

Reasons for it include:

Cardiovascular insufficiency. Leads to stagnation of blood, causing. Pericarditis, the threshold of the heart are accompanied by an increase in such an indicator as hydrostatic pressure, contributing to the accumulation of fluid in the pleural cavity.
insufficient function thyroid gland inhibits the metabolism of proteins, slows down their absorption, which causes dystrophy. Violation biochemical processes contributes to the creation of protein deficiency in the blood plasma.
Pathology of the kidneys. severe forms diseases associated with nephrotic syndrome, renal failure, are characterized by a significant loss of protein. As a result, the plasma enters the pleural cavity. Usually, kidney disease leads to the development of bilateral hydrothorax..
Cirrhosis of the liver with ascites. The fluid, penetrating into the pleural cavity, located on the right, forms a right-sided hydrothorax. The liver type is diagnosed only when the volume of fluid exceeds 0.5 liters, and there are no abnormalities in the work of the heart and lungs.

Neoplasms can be another cause of hydrothorax, however, they are extremely rare in the mediastinal region.

Symptoms of hydrothorax

Signs of this disease are minimal until the volume of fluid exceeds 150 ml. This usually does not affect the underlying disease. Hydrothorax - what it is is easy to determine if there are independent signs. They occur when too much fluid accumulates in the lungs. For severe pathologies of cardio-vascular system excess fluid can fill the pleural cavity, as well as the pericardial and abdominal. Symptoms develop gradually as exudate accumulates.

The main complaints that patients with hydrothorax most often address are:

Dyspnea. Its intensity depends on how pronounced the starting process is. It first occurs during physical activity, then it is also found at rest. Severe shortness of breath indicates.
Heaviness below chest cavity.
Labored breathing. There is a lack of air. To help open a healthy area of the lung, a patient with right-sided or left-sided hydrothorax has to lie on one side.
Cyanosis. A bluish tint to the skin is another indicator of respiratory failure. With moderate hydrothorax, acrocyanosis is observed - a slight blue discoloration of the subungual areas, lips, and the tip of the nose. There are difficult situations when there is acute heart failure, a bluish color spreads throughout the body.

Absence inflammatory process, when fluid accumulates in the pleural cavity, explains the fact that there is no pain syndrome with hydrothorax.

On examination, there is no noise in the area of exudate accumulation. In a process involving only the right or left half chest, there is a noticeable lag of its affected part during breathing. Fluid in the pleural cavities can be detected by a physical examination of the patient. The chest is palpated with fingers, tapped.

Hydrothorax associated with cirrhosis of the liver respiratory failure characteristic even when small.

Examination methods

After an initial examination by the attending physician, various methods diagnostics.

When the amount of liquid is more than 100 ml, objective assessment the patient's condition is given by x-ray examination. The fluid in the picture is presented in the form of a uniform darkening, which moves freely when changing the position of the body.

Diagnosis using ultrasound recognizes hydrothorax in the lung even with the accumulation of 15 ml of fluid. The method allows you to accurately determine the volume of exudate, to identify the best place for puncture. This procedure required to draw fluid from pleural cavity for the purpose of research.

Before treating the disease, it is necessary to establish a more accurate picture of the disease.

To do this, the patient is invited to pass the following types of tests:

General blood analysis. Helps to identify the source of the disease associated with kidney pathology. Talks about it elevated ESR the presence of anemia.
Biochemical blood test. Discovered with it reduced level plasma protein, a large number of nitrogenous slags indicates a violation of the activity of the kidneys. An increase in the amount of bilirubin (both direct and indirect), hypoproteinemia are the main indicators of the existing liver pathology.
Analysis of urine. It helps to establish existing kidney diseases based on indicators such as urine density, white blood cell count, red blood cells.
Rivolt's test is a study of fluid from the pleural cavity. The method helps to distinguish exudate from transudate. Fluid is obtained by puncture. Place 2 drops of it in an acidic environment, where the protein denatures and forms a cloudy precipitate, which is used to determine the exudate.
Cytological study. Fluid from the pleural region is taken for analysis. It is centrifuged, the sediment is taken, from which special smears are prepared, staining them using the Romanovsky-Giemsa method. With hydrothorax, there are no tumor cells.

To rule out the diagnosis of tuberculous pleurisy, bacteriological examination obtained by fluid puncture. It is planted and the results are evaluated.

Video

Video - Symptoms and treatment of hydrothorax of the lungs

Medical tactics

With insufficiently pronounced hydrothorax, treatment includes various therapeutic measures aimed primarily at eliminating the main disease.

In heart failure, it is recommended to optimize the mode of work and rest, avoid stress, get enough sleep. It is necessary to adhere to certain diets under number 10 or 10 A. She assumes fractional nutrition at which the number of meals per day should be at least five. At the same time, the use of water and edible salt is limited.

From medicines appointed:

Means that reduce contractility myocardium.
Potassium-sparing diuretics, other drugs that perform a diuretic function, helping to remove excess fluid from the body.
Vasodilator drugs that unload the left ventricle.

The development of hydrothorax caused by kidney pathology requires a different treatment. The patient is advised to stay in bed. Diet number 7 is prescribed, the feature of which is the restriction of consumption table salt or complete failure from it, if puffiness is strongly expressed. Be sure to control the amount of fluid drunk. It should not exceed the amount of urine excreted by more than 300 ml. For normal maintenance protein metabolism, you must adhere to a certain diet. Of the medicines, drugs are prescribed that allow you to retain the protein, preventing it from being washed out with urine.

In the treatment of hydrothorax associated with cirrhosis of the liver, it is necessary to observe drinking regimen drinking no more than 1.5 liters of fluid per day. It is required to follow a diet number 7limiting salt intake. Protein should be supplied to the body in sufficient quantities - at least 70 g per day.

Fluid builds up in the pleura and compresses the lungs, making it difficult to breathe.. Then a puncture is scheduled. Its purpose is to remove the liquid. It is then examined to make sure correct diagnosis diseases. After the procedure for cleansing the pleural cavity from the accumulated fluid, the patient's blood circulation is restored, respiratory processes, unpleasant symptoms disappear.

Traditional medicine also helps to cope with hydrothorax. The disease has been known to people for a long time. Our grandmothers knew what it was. Therefore, today the treatment is used folk remedies.

Helps speed up recovery onion juice, parsley tincture. Any type of hydrothorax can be cured by supplementing the course of therapy with prescriptions traditional medicine. They should be used only after consulting a doctor.

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Hydrothorax is not a specific disease, but a pathological condition that occurs against the background of a number of diseases. It is characterized by the accumulation of fluid (transudate) different quantity in the pleural cavity of the lungs. Such a pathology is dangerous for human health, because due to the development of hydrothorax, the process of gas exchange is disturbed, and suffocation appears.
What diseases are accompanied by a pathological accumulation of effusion in the pleural cavity, how the condition manifests itself and what is the provision of assistance to the patient, is discussed in the article.

The main reason for the accumulation of fluid is the failure of the heart and blood vessels, which is accompanied by congestion. It's about about the following diseases:

decompensated heart defects;
inflammation of the heart bag of a non-inflammatory nature.

These pathological conditions are characterized not only by an increase in hydrostatic pressure figures, but also by a decrease in the colloid osmotic pressure of blood plasma.
The following reasons for the development of hydrothorax are diseases of the urinary system. This is a severe form of glomerulonephritis, kidney failure, amyloidosis. The accumulation of fluid in the pleural cavities occurs as a result of an increase in the amount of protein in the blood (hyperproteinemia). In most cases, kidney damage leads to bilateral hydrothorax.
Against the background of ascites (abnormal accumulation of fluid in abdominal cavity) and degenerative-destructive liver disease in the form of cirrhosis, every tenth patient develops right-sided hydrothorax. Ascites provokes the development of pathology due to a violation anatomical features domes of the diaphragm.

Tumor processes - possible reason clusters pleural fluid. These are the following states:

primary breast cancer (BC);
primary tumor of the mediastinum;
breast cancer (BC) or mediastinal cancer, which appeared through metastasis of a tumor of another organ.

Classification

There are several divisions of hydrothorax: by the nature of the pathological fluid, by its quantity, depending on which half of the chest is affected.
By the nature of the pathological fluid:

accumulation of blood in the pleural cavity - hemothorax;
accumulation of lymph in the pleural cavity - chylothorax;
accumulation of pus in the pleural cavity - pyothorax;
accumulation of transudate (non-inflammatory fluid with a small amount of protein) in the pleural cavity - hydrothorax.

By the amount of pathological fluid:

hydrothorax of the minimum type (up to 0.1 l of fluid) - is determined exclusively during a CT scan of the chest, there may be no symptoms of pathology;
hydrothorax of a small type (up to 0.5 l of fluid) - determined using a chest x-ray;
hydrothorax of the middle type (0.5-1.5 l of liquid) - accompanied by compression of the lung and impaired respiratory function;
hydrothorax of a pronounced type (more than 1.5 liters of fluid) - sharply impaired respiratory function up to suffocation.

Depending on which half of the chest is affected, which leads to the development of hydrothorax, there is a right-sided and left-sided pathology. The defeat of both halves of the chest is called a bilateral (total) process.
There is another variant of the pathological condition - encysted hydrothorax. The term "encapsulation" denotes the transition of an acute process into a chronic disease. This type of accumulation of fluid in the pleural cavity occurs against the background of encysted pleurisy, a disease caused by Koch's wand.

Pathology develops, as a rule, behind, above the diaphragm or in the lateral part of the pleura. In most cases, the fluid that accumulates in the lungs is pus.

ICD-10 code

The International Classification of Diseases of the 10th revision (ICD-10) gives hydrothorax a separate code - J94.8. Its name is "other specified pleural conditions".

Symptoms and signs of hydrothorax

The development of hydrothorax is manifested alongside clinical signs, the severity of which depends on the amount of pleural fluid. Specific symptoms are:

Shortness of breath of varying intensity, which may progress. First occurs during physical activity, later and during rest.
Cyanosis skin. Against the background of insufficiency of the heart muscle, acrocyanosis is clearly visible during examination (cyanosis of the fingertips, nose, lips, nail bed). With an increase in respiratory failure, cyanosis appears throughout the body.
Unilateral hydrothorax (right- or left-sided) leads to the fact that it is possible to visually determine the lag of one half of the chest in the act of breathing from the second. The bilateral process is not characterized by pronounced visual changes.
The affected half of the chest increases in size, swelling of the spaces between the ribs is noticeable.
The patient takes a forced position to compensate for respiratory failure.

Important! The appearance of shortness of breath, cough without sputum production are symptoms of the development of hydrothorax, which confirm the progression of acute respiratory failure.

The pain syndrome is not typical for the accumulation of pleural fluid in hydrothorax. Pain can appear either at the beginning of the process, or at the time of the patient's recovery (it occurs as a result of rubbing the pleural sheets against each other).
A qualified specialist can determine the presence of puffiness lower extremities on examination, even total anasarca-type edema. The accumulation of pathological fluid (transudate) is also determined in the heart sac.

Tests for hydrothorax

The development of hydrothorax must be confirmed with a series of studies in order to correctly differentiate the pathology.
Percussion and auscultation data
A research method in which doctors tap the chest with their fingers. A change in the sound resulting from percussion indicates the presence pathological process. Tapping determines the presence of a dull sound, the border of which looks like a curved line.

The study allows you to clarify the presence of fluid in the pleural cavity, even in a small amount. If the patient changes the position of the body in space, the level of the transudate also changes, which confirms the presence of pathology.
Listening to the lungs with a phonendoscope determines the weakening of respiratory sounds, in some cases they complete absence(with the accumulation of a large amount of fluid), weakening or absence of trembling of the voice on the side of the lesion.

radiograph

One of the diagnostic methods is x-ray. Diagnosis is carried out in a standing position. The picture of the obtained picture may be different, depending on the amount of transudate in the pleural cavity.
As a rule, in the projection of the affected lung, it is possible to determine the presence of darkening with certain boundaries. The upper border is slightly skewed, it arises from the difference between atmospheric pressure and pressure in the pleural cavity.

Important! If the patient does not have hydrothorax, but pneumothorax, upper bound becomes horizontal. This sign allows for differential diagnosis.

The amount of accumulated fluid with x-ray examination impossible to determine. The error in the calculations reaches 0.5 liters. In this case, CT will help. In addition, in the picture of the study, you can determine the offset internal organs to the healthy side.
The use of ultrasound also allows you to specify the amount of non-inflammatory fluid containing a small amount of protein, pus, blood in the lungs. With the help of ultrasound, even 10-20 ml of pleural fluid can be determined. The same method is used to control during a pleural puncture.

Pleural puncture

With hydrothorax, a pleural puncture is performed both for the purpose of treatment and for the purpose of diagnosis (the resulting transudate is examined to confirm the diagnosis). In most cases, the procedure is performed urgently, there is no time for patient preparation.
The patient takes a sitting position, leaning forward, resting his hands on the table. The puncture site is not chosen by chance. The doctor determines it with the help of percussion and ultrasound. More often choose 7-8 or 8-9 intercostal space from the scapular to the posterior axillary line.

Technique for pleural puncture with hydrothorax:

The skin is treated with antiseptic solutions.
Local anesthesia is administered to reduce pain.
The doctor makes a puncture, moving the instrument along the upper edge of the rib in the selected intercostal space.
To prevent lung puncture, the doctor fixes the movement of the instrument with his fingers.
The syringe is changed to special system for pleural puncture. The exudate is removed, however, not more than 1000 ml per manipulation. Evacuation more can lead to sharp drop blood pressure and cardiopulmonary insufficiency.
The specialist removes the needle, seals the puncture site with a plaster.
30 minutes after the pleural puncture, the patient's condition is assessed, an X-ray examination is performed.

Laboratory study of effusion

After the evacuation, the material should be given for analysis to assess its nature. Depending on the protein level, the presence of hydrothorax in the patient is confirmed. If a transudate accumulates in the pleural cavity, the effusion will have the following characteristics:

protein level less than 30 g/l;
yellow;
lack of smell;
no sediment during settling;
low specific gravity;
glucose level is above 3.3 mmol/l.

Additional Research

These diagnostic methods make it possible to differentiate the cause of the underlying disease that caused the development of hydrothorax. These include an electrocardiogram and ultrasound diagnostics heart and internal organs.
Laboratory methods consist of

biochemical blood test;
clarification of indicators of thyroid hormones;
urinalysis;
general blood test.

Treatment of hydrothorax

Help for a patient with hydrothorax is provided depending on the disease that provoked the accumulation of effusion in the pleural cavity.
If the cause is heart failure, the patient is advised to limit the amount of fluid and salt entering the body, correct nutrition, and record the amount of urine excreted. The main treatment is cardiac glycosides (Digoxin) and diuretics (Veroshpiron).
In addition, the doctor may prescribe Nitroglycerin, Captopril, which reduce the load on the left sections of the heart muscle. Mandatory constant monitoring of pressure, protein levels in the blood and urine.
Hydrothorax of renal origin requires daily monitoring of the amount of urine excreted, a ban on salt intake. Albumin solution is injected into a vein. Assign diuretics, drugs that preserve the protein in the body (Ramipril).
Treatment of hydrothorax in liver diseases includes:

therapeutic thoracocentesis;
diuretics;
antibiotics (cephalosporins, fluoroquinolones);
surgical treatment (shunt placement, organ transplantation).

Forecast

Timely treatment of the underlying disease and evacuation of effusion from the pleural cavity provide favorable outcome pathology. The most severe variants of hydrothorax are characteristic of progressive heart failure in the stage of decompensation. In addition, in the background severe pathologies internal organs (in particular the liver), transplantation may be the only option for successful treatment.

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Diseases of the kidneys, cardiovascular system, malignant tumors, hormonal disorders and other systemic problems of the body can provoke the occurrence special disease– . Non-inflammatory fluid accumulates in the chest, disrupting normal functioning respiratory organ. There is shortness of breath, general weakness, loss of strength. In severe cases and in the absence necessary assistance even death is possible.

What is pathology?

What is pulmonary hydrothorax? This is a condition in which a non-inflammatory fluid (transudate) accumulates in the lungs. It is located between two pleurae: covering the respiratory organ from the outside and located with inside chest.

A small amount of transudate is present and absolutely healthy person. It is necessary to ensure better sliding of the pleura. When pathology occurs, the volume of the transudate increases. It can range from 10 ml or less to several liters.

The disease develops as a consequence of other diseases in the absence or insufficiency of treatment.. It can capture both halves of the lung, i.e. be bilateral, or concentrate in one part of the respiratory organ - right-sided or left-sided hydrothorax.

A special type of pathology is encysted, i.e. relapsing, relapsing chronic condition. It is caused by encysted pleurisy, a disease that occurs under the action of the pathogen - Koch's bacillus, which is difficult to cure.

Important ! Pathology can develop not only in an adult. There is a special diagnosis - hydrothorax in the fetus, which is based on the results of ultrasound, dopplerography. Measures therapeutic effect determined according to the severity of the case.

What are the causes of hydrothorax of the lungs?

The cause of hydrothorax is the ingress of the liquid component of the blood into the gap between the pulmonary pleurae. This situation can be caused by two factors: an increase in hydrostatic pressure or a decrease in oncotic pressure.

The development of the disease is often associated with the following diseases:

Heart failure - blood stagnates, increased hydrostatic pressure is created, transudate accumulates between the two pleurae.
Kidney disease - proteinuria, swelling leads to a reduction in the amount of protein, which lowers oncotic pressure.

Ascites - fluid accumulates in the abdominal cavity, from where diffuse method enters the lungs.
Malignant tumors in the lungs - with oncology, the normal movement blood, lymph, which leads to an increase in pressure.

Protein deficiency associated with metabolic disorders, thyroid hormone deficiency or wrong diet nutrition. Osmotic pressure falls, the liquid part of the blood goes into the cavity of the lungs.
Cirrhosis of the liver - leads to hydrothorax due to the fact that against its background the amount of protein in the blood decreases, ascites develops.

Most often, hydrothorax of the lungs leads to late or insufficient treatment of underlying diseases, non-compliance with doctor's recommendations, or passion for untested folk methods.

Of particular danger is hydrothorax of the lungs during pregnancy.. It can occur against the background of systemic diseases (cardiovascular diseases, kidney problems, etc.), lack of vitamins A, B and other factors. When the first symptoms of pathology appear expectant mother you need to see a doctor urgently.

Typical symptoms of hydrothorax of the lungs

Signs of hydrothorax depend on the volume of transudate in the pleural cavity and the affected area. They are most often combined with symptoms of the underlying disease that caused the problem, for example, with manifestations of heart disease.

Allocate the following symptoms indicating the development of pathology:

Shortness of breath - it can be severe or barely noticeable (depending on the degree of development of hydrothorax).
At first, it disturbs the patient only when moving, then it occurs at rest.

Cyanosis of the skin - manifested by a change in the color of the nasolabial triangle and the skin under the nails. In severe cases, skin tone changes throughout the body. it feature hydrothorax associated with heart failure.
A noticeable lag in breathing of the affected lung from the healthy one is a clear symptom of a unilateral process.
Change in the shape of the chest - with the accumulation of a large amount of fluid, the diseased half of the lung protrudes forward.
Forced posture on one side - when the patient lies on the affected part, the patient opens up better, and breathing difficulties disappear.
Dry cough is a consequence of compression of the lung and the loss of its ability to perform respiratory movements.
Swelling of the legs, feeling general weakness, lack of strength to perform simple household chores.
Pain in the chest with hydrothorax is rare. It can occur only at the beginning of the pathological process or at its completion, when the resulting fluid is absorbed and the pleural sheets rub against each other.

Methods for diagnosing patients with hydrothorax

used to detect pathology the following methods laboratory diagnostics:

Radiography
This method is effective if the amount of accumulated transudate exceeds 100-150 ml. On x-ray, it looks like a uniform darkening, curved to the right or left. If the pathology has reached significant volumes, it is unilateral, the affected half of the lungs looks dark in the picture, the organs are noticeably shifted to the healthy side.
Laterography
For the study, the patient lies on his side. The accumulated liquid looks like a uniform dark strip.
Ultrasound procedure
It's over exact method than an x-ray because it shows pathology if the fluid volume is more than 10 ml. The study helps to determine from which place it is better to take a puncture.
Taking a puncture
In medicine, hydrothorax is any accumulation of fluid, the nature of which has not been established. To determine the structure of the material, a puncture is taken from the patient, making a puncture of the chest tissue with a special needle. Further examination of the transudate allows us to understand whether the pathology is inflammatory or non-inflammatory in nature. For this, the Rivolta test is used.

Pathology appears in diseases of the cardiovascular system, therefore, to identify the causes of its development, appointment proper treatment often needed additional research: ECG, ultrasound of the heart or kidneys, general, biochemical analyzes blood, etc. Hydrothorax of the lungs in oncology requires additional histological examination biomaterial.

Video

Video - Diagnosis of hydrothorax. Percussion of the lungs

How to treat pathology?

Treatment of hydrothorax depends on the cause that caused it. Therapeutic efforts should be directed towards eliminating the underlying disease. The patient needs hospitalization: this measure will make it possible to control his condition, to prevent the situation from developing into a critical one.

To eliminate hydrothorax in heart failure, the patient needs to optimize the daily regimen, fully relax, get enough sleep, avoid stressful situations. It is necessary to follow a diet number 10: to minimize the amount of fluid consumed, sodium chloride. You should eat 5-6 times a day in small portions.

To eliminate the underlying disease, the patient is prescribed medications that increase myocardial contractility, diuretics, vasodilator drugs, etc. Self-medication is unacceptable, all actions must be coordinated with the doctor.

To combat hydrothorax of the lungs in kidney disease, patients are prescribed bed rest which stimulates the production of urine. Diet 7 is recommended, which involves limiting salt intake (sometimes to 0), controlling the amount of fluid you drink. Medical therapy includes taking diuretics and drugs that reduce or replenish protein losses.

If hydrothorax of the lungs was the result of cirrhosis of the liver, the patient is prescribed the seventh diet with a restriction on daily consumption liquids in 1.5 liters. The diet is designed in such a way as to increase the content of protein products. In some cases, diuretics are needed.

If pregnancy was a factor in the development of hydrothorax, the expectant mother, in addition to drug therapy, is prescribed salt-free diet, limiting the amount of liquid. A woman needs to rest more, walk on fresh air avoid anxiety and stress. The condition should be monitored by an experienced doctor.

Important ! Any treatment for hydrothorax should be done by a doctor. Folk methods, self therapy not only ineffective, but very dangerous.

In severe cases, medical treatment is not enough, so a puncture is required to pump out the accumulated fluid. It is carried out during development, due to the fact that the lung is compressed by a transudate.

The puncture is done under local anesthesia, no preliminary measures are required. In one procedure, you can remove up to 1 liter of fluid. If the pathology is large, several consecutive sessions may be necessary.

In the treatment of puncture method, the prognosis is favorable. Complications of this method are extremely rare, to avoid them, you need to carefully consider the choice of a doctor. Recurrent hydrothorax may require a second procedure.

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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. independent disease hydrothorax cannot be named, 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 take several forms, hallmark while its localization is:

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

The most common is bilateral hydrothorax. This phenomenon can be explained following fact. The presence of an underlying disease causes the accumulation of pleural fluid first in one lung (right or left). Absence is bright severe 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 sharp rise 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 cardiovascular system or birth defects hearts. The list of such pathologies includes chronic heart failure (known by the abbreviation CHF). With such indicators in different areas body, blood stasis occurs, provoking hydrostatic pressure. The result of such changes in the body is often the transition of fluid into the pleural region.
kidney disease 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, chest injury.
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 - different great content accumulated fluid;
bagged.

Depending on the characteristics of the pathology, it will differ and clinical picture. 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. On 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. Standing and sitting unpleasant feeling 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 the result of a long 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 on initial stage process pathology will not be detected, 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 seizures nausea, they quite often end in vomiting.

During examination of the patient at this stage of hydrothorax lung 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 examination. The reason for this is the symptoms that are characteristic of many diseases. To reveal everything related complications need to be examined.

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

X-ray. For suspected lung disease X-ray- 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. Through this study, physicians are able to identify chemical composition substances 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).

Treat hydrothorax easy folk means is strictly prohibited. Incorrect choice treatment can result in serious complications for the patient.

Complications with hydrothorax

Most frequent complication with dropsy of the lungs, acute respiratory failure becomes. 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

Perhaps drug treatment, however, it is shown 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 antibiotics. a wide range actions.

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 must refuse 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, it is necessary 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 where given state caused oncological processes. In this case, a long and difficult treatment is ahead.

In severe form, other diseases can be complicated by hydrothorax. In the people, this pathological condition is known as chest dropsy.

What is pulmonary hydrothorax?

Hydrothorax of the lungs is a disease in which fluid accumulates in the pleural cavity. Most often, the exudate is non-inflammatory in nature. Pathology is not independent, it mainly aggravates the course of the underlying disease. Hydrothorax is able to become a companion of diseases, which are characterized by blood stasis observed in the pulmonary circulation, high blood pressure.

The disease can take three forms:

left-sided (the rarest);

right-sided (rare);

bilateral (the most popular).

A person may first have a right-sided (left-sided) hydrothorax, then transform into a bilateral form.

Also, hydrothorax is traditionally divided into following groups:

simple hydrothorax;

chylothorax (lymph is concentrated in the pleural cavity);

redness of the skin;

puffiness;

swelling of the fingers;

slight increase in temperature;

difficulty falling asleep.

In addition, with hydrothorax, the patient may experience an increase in the size of the lymph nodes, the appearance of pain in muscles, stiffness of movements. And, finally, if a large amount of fluid is collected, deformation of the affected half of the chest occurs. The intercostal spaces are smoothed, the chest protrudes. It is easier for the patient to lie on the affected side, since pressure from above can be avoided in this position.

If a patient has hydrothorax, moderate in volume, the fight against the disease against which he developed comes to the fore. Depending on the indications, protein, diuretic drugs, medications for the treatment of heart failure.

Puncture with aspiration

If a large volume of fluid is collected in the pleural cavity, the patient develops respiratory failure, the lungs are compressed, he is prescribed a puncture. The main goal of the manipulation is the slow removal of the transudate from the cavity. Suction is performed using a special thick and long needle. The procedure can also be carried out in order to clarify the diagnosis. The fluid is analyzed, which makes it possible to verify the correctness of the verdict "hydrothorax", without confusing it with hemothorax or exudative pleurisy.

For the procedure, the patient takes sitting position. Used for pain relief local anesthesia, an injection is made at the lowest point of the pleura. For one procedure, a maximum of 1.5 liters of liquid is “sucked off”. If this amount is exceeded, there is a danger of displacement of the mediastinal organs. It may also decrease arterial pressure. After the puncture, the puncture site is covered with a sterile dressing.

Purification of the pleural cavity from pathological fluid allows you to restore blood circulation, "start" the respiratory processes. it simple procedure you don't need to prepare for it. If the problem is recurrent hydrothorax, the pleural cavity is punctured again, in difficult cases- repeatedly.

Treatment of major diseases

Despite the simplicity of the puncture, doctors try to limit themselves conservative treatment illness. Frequent repetition of fluid aspiration provides severe protein loss, possibly worsening gynoproteinemia.

If hydrothorax appears in a patient against the background of cirrhosis of the liver, he is prescribed a diet that reduces the intake of salt and fluid containing enough squirrel. Diuretics are also included, if indicated.

If the disease is associated with kidney disease, the appearance of nephrotic syndrome, the patient is shown bed rest to improve urine production. A diet is also prescribed that reduces the allowable amount of salt (or completely excludes this product if the patient has puffiness), the liquid being drunk is monitored. Drug therapy is also connected (depending on the specific disease).

In heart failure, the patient is prescribed fractional meals, special diet program, good sleep avoidance of stressful situations. Medical therapy is also used. Cardiac glucosides, phosphodiesterase inhibitors are prescribed to enhance contractile function myocardium. With the help of diuretics, the body gets rid of excess fluid. Drugs are also taken that reduce the load that falls on the left ventricle of the heart.

The best prevention hydrothorax - timely and adequate treatment of diseases that can create conditions for its development. It is also recommended to avoid any injury to the chest.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow medical institute them. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 " Occupational diseases", in 1996 "Therapy".