Hydrothorax

HYDROTHORAX, hydrothorax (from the Greek hydor—water and thorax—chest), thoracic dropsy, a non-inflammatory accumulation of fluid (transudate) in the pleural cavity. Hydrothorax is in most cases a secondary phenomenon, developing in diseases accompanied by general dropsy (such as nephrosis or glomerulonephritis, heart disease, hunger edema, severe anemia, cachexia), as well as during compression of the superior vena cava and the thoracic duct by a tumor. The basis of the condition is apparently a disorder in the nutrition of the vessel walls, their increased permeability, and a decrease in absorption by the lymphatic system. Usually, hydrothorax develops simultaneously on both sides. Sometimes it occurs on one side, on which the patient usually lies, where more fluid accumulates. In cardiac patients of advanced age, hydrothorax often develops only on the right side and does not resolve for a long time, even if cardiac activity improves. The symptoms are the same as in exudative pleurisy, but unlike pleural exudate, the transudate, due to the absence of adhesions, shifts significantly more when the position is changed, and its upper boundary is more horizontal. The increase in hydrothorax usually occurs slowly, does not reach large dimensions, and, being usually bilateral, rarely causes displacement of adjacent organs. Diagnosis in most cases does not present difficulties. Bilateral accumulation of pleural fluid, its mobility, horizontal upper boundary, absence of pleural friction rub, pain, and usually fever, in the presence of general dropsy, severe heart or kidney disease, or other diseases indicated above, are sufficient to distinguish hydrothorax from exudative pleurisy. In addition, pleural fluid during a trial puncture is characterized by a lower protein content, lower specific gravity (less than 1.015), lower content of cellular elements (with the exception of endothelial cells), and weakly expressed ability for spontaneous coagulation. The Rivalta test is mostly negative. In cases of difficulty in determining the presence of hydrothorax, the patient can be placed on their side. In the case of the presence of transudate, a strip of dullness will appear after some time near the spine on the upper side. Prognosis depends on the nature of the underlying disease. In the case of prolonged hydrothorax, atelectasis of the corresponding lung may develop. Therapy is reduced to the treatment of the underlying disease. To reduce the accumulated fluid, cardiac and diuretic agents are indicated. In case of severe shortness of breath, depending on the large accumulation of fluid, removal of part of it by puncture is indicated (see Pleurisy). Literature: Granstrem E., Diseases of the Pleura (Private Pathology and Therapy of Internal Diseases, edited by G. Lang and D. Pletnev, volume III, pp. 286-288, Moscow-Leningrad, 1927); Geigel R., Lehrbuch der Lungenkrankheiten, p. 291-296, Munchen-Wiesbaden, 1922; Siegel M., Zur Frage des Hydrothorax ex vacuo, Wien. Klin. Wochenschrift, 1904, No. 18; Plercy H., A physical problem in bilateral hydrothorax, Journ. of the Americ. med. association, v. LXXXIV, No. 3, 1925.