2023 Author: Josephine Shorter | [email protected]. Last modified: 2023-05-24 11:52
Right-sided and left-sided hydrothorax of the lungs
Heart failure, kidney disease, severe anemia, and other illnesses can be complicated by hydrothorax. Popularly, this pathological condition is known as pectoral 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. Pathology is not independent, in general, it aggravates the course of the underlying disease. Hydrothorax can become a companion of diseases for which blood stagnation, observed in the pulmonary circulation, and high blood pressure are typical.
The disease can take three forms:
- left-sided (the rarest);
- right-sided (rare);
- bilateral (most popular).
A person may first develop a right-sided (left-sided) hydrothorax, then transform into a bilateral form.
Also, hydrothorax is traditionally divided into the following groups:
- simple hydrothorax;
- chylothorax (lymph is concentrated in the pleural cavity);
- hemothorax (blood is collected in the pleural cavity).
The amount of fluid that accumulates in the pleural cavity during hydrothorax can vary from 100 ml to several liters. As a rule, the manifestations of the patient's disease do not bother if the volume of exudate does not go beyond 200 ml
Hydrothorax causes compression of the lung tissue, a decrease in its size, this happens if fluid collects in large quantities. Displacement of the mediastinal organs is also likely. The result of the process can be respiratory failure, impaired blood circulation, and therefore it is extremely dangerous to leave the disease without treatment.
Hydrothorax can provoke a heart attack in a patient, become a source of kidney and liver problems, cause pulmonary edema and other dangerous complications.
Causes of hydrothorax
Many diseases that trigger high blood pressure can cause a person to develop hydrothorax.
Among them, the following diseases, pathologies are most common:
- tumors of the mediastinum;
- cirrhosis of the liver;
- defects, heart disease (genetic, acquired);
- malabsorption syndrome;
- diseases affecting the kidneys;
- chest trauma;
Kidney disease leads to a decrease in blood plasma pressure, resulting in hydrothorax. Similarly, the disease develops with myxedema, alimentary dystrophy. With cirrhosis of the liver, pathology may also be associated with the movement of ascitic fluid into the pleural cavity from the abdominal cavity. Almost the same thing happens with peritoneal dialysis, ascites. Tumors of the mediastinum become a provocateur due to a violation of the outflow of lymph and blood.
Also, a factor provoking the development of the disease can be a metabolic disorder (salt, water, protein).
Symptoms of hydrothorax
If the pathological accumulation of fluid takes on serious forms, the patient begins to be bothered by shortness of breath, there is always a feeling of heaviness in the affected half of the chest (in the right, left, both, depending on the form of hydrothorax).
Also, the disease speaks of itself with the following symptoms:
- forced posture (the upper body is raised, tilt towards the concentration of fluid);
- chest pain;
- dry cough;
- redness of the skin;
- 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, pain in the muscles, and stiffness of movements may occur. 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 in this position pressure from above can be avoided.
If the patient has hydrothorax, moderate in volume, the fight against the disease, against which he developed, comes to the fore. Depending on the indications, proteinaceous, diuretic drugs, medications for the treatment of heart failure can be prescribed.
Puncture with aspiration
If a large volume of fluid is collected in the pleural cavity, the patient's respiratory failure progresses, the lungs are compressed, and a puncture is prescribed. The main purpose 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 a sitting position. For pain relief, local anesthesia is used, an injection is made at the lowest point of the pleural area. During one procedure, a maximum of 1.5 liters of liquid is "sucked". If this amount is exceeded, there is a danger of displacement of the mediastinal organs. Blood pressure may also drop. After puncture, the puncture site is closed with a sterile bandage.
Cleansing the pleural cavity from pathological fluid allows you to restore blood circulation, "start" the respiratory processes. This is a simple procedure, you do not need to prepare for it. If recurrent hydrothorax is a problem, the puncture of the pleural cavity is repeated, in difficult cases - several times.
Treatment of major diseases
Despite the ease of puncture, doctors try to limit themselves to conservative treatment of the disease. Frequent repetition of aspiration of fluid leads to a serious loss of protein, possibly worsening hypoproteinemia.
If hydrothorax appears in a patient with cirrhosis of the liver, he is prescribed a diet that reduces the intake of table salt and fluids, containing a sufficient amount of protein. Diuretics are also connected, 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 permissible amount of salt (or completely excludes this product, if the patient has swelling), the fluid being drunk is monitored. Drug therapy is also connected (depending on the specific disease).
With heart failure, the patient is prescribed fractional meals, a special dietary program, good sleep, and avoidance of stressful situations. Drug therapy is also used. Cardiac glucosides, phosphodiesterase inhibitors are prescribed to enhance the contractile function of the 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 of hydrothorax is timely and adequate treatment of diseases that can create conditions for its development. It is also recommended to avoid any damage to the chest.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".