Pericardial effusion : causes, symptoms and treatment of hydrothorax

Category Disease | December 12, 2017 00:03

Exudative pleurisy( hydrothorax) is a dangerous disease of the respiratory system, which is characterized by the development of the inflammatory process in the pleura with the subsequent accumulation of exudate( effusion) in it. The ailment is cunning because it affects people from different age groups, but most often its targets are people of working age. Hydrotorax can develop as an independent disease, but in most clinical cases, its formation was promoted by inflammatory or infectious diseases of the lungs and other organs.

  • Mechanism of
  • Classification of
  • Reasons for
  • Symptoms of
  • Phases of
  • Diagnosis of
  • Treatment of
  • Prevention of

Exudative pleurisy is not widely recognized as a widespread ailment. According to the latest statistical data, it was found that this pathology affects about one million people per year. This is due to the fact that it complicates the course of other diseases in traumatology, pulmonology, cardiology, phthisiology and others. Very often exu

date in the pleura is a consequence of the complication of the underlying disease, so doctors need to thoroughly study the patient's medical history, to conduct additional studies involving thoracic surgeons and pulmonologists.

The mechanism of

Hydrothorax affects exclusively the pleural cavity. It is a closed space on all sides. In this cavity there is always a certain amount of effusion. Norm - no more than 10 ml. In one hour the pleura produces about 100 ml of liquid. This is a normal physiological process, completely harmless to human health. Produced exudate absorbs capillaries and lymphatic vessels. Under the influence of adverse factors, the production of exudate can increase and the pleura will not be able to completely adsorb it. The residues will concentrate in the cavity. This will lead to the development of exudative pleurisy( right-sided or left-sided).

Classification of

Hydrotorax has several basic forms:

  • depending on the nature of the course: acute, subacute and chronic form;
  • , depending on the etiology: infectious( eg, tuberculosis etiology) and non-infectious;
  • according to the nature of the effusion distinguish: serous, serous-purulent( exudate pus), purulent, cholesterol and hemorrhagic( the most dangerous);
  • , depending on the anatomical shape: local( which is also subdivided into the parietal, apical, diaphragmatic, etc.) and diffuse.

Reasons for

A common cause of development of infectious exudative pleurisy is the penetration of infection, viruses and bacteria that caused the development of the underlying ailment into the pleural cavity. More than 80% of cases of development of hydrothorax are observed in patients whose history records the main diagnosis of "pulmonary tuberculosis".

Infectious exudative pleurisy develops due to penetration into the cavity of specific and nonspecific pathogens:

  • mycobacterium tuberculosis( promote the development of hydrothorax tubercular etiology);
  • of staphylococci;
  • pneumococci;
  • streptococci;
  • Haemophilus influenzae;
  • Pseudomonas aeruginosa;
  • brucella;
  • viruses;
  • echinococci;
  • fungi;
  • protozoa.

Separately it is necessary to allocate hydrothorax tubercular etiology .Its main cause of development is an increase in the sensitivity of the patient's body to Koch's stick. This process in medical circles is called "sensitization".As a result, if several microbes enter the cavity of the pleura, the reactive effusion will begin to accumulate several times faster. And in this situation it is a serious complication, which can lead to death. Tuberculosis hydrothorax affects mainly adult patients, practically without affecting children.

Tuberculous hydrothorax

Main causes of noninfectious exudative pleurisy:

  • renal failure in chronic form;
  • trauma of the chest, in which a hemorrhage began in the cavity of the pleura;
  • blood tumors predominantly malignant;
  • chronic circulatory failure;
  • infarction of the lung;
  • cirrhosis of the liver( common cause of right-sided hydrothorax);
  • connective tissue diseases of an autoimmune nature. They include collagenoses, rheumatism and others;
  • carcinomatosis, mesothelioma and other malignant tumorous formations in the lungs;
  • with inflammation of the pancreas may develop a left-sided hydrothorax.

Symptoms of

The severity of symptoms of exudative pleurisy directly depends on two factors:

  • severity of the pathology( particularly severe hydrothorax tubercular etiology);
  • speed and volume of effusion.

Clinical picture, characteristic for pleurisy with accumulation of exudate:

  • dry cough;
  • increased fatigue;
  • weakness in the whole body;
  • skin becomes bluish;
  • from the localization of the lesion of the patient feels heaviness;
  • there may be a feeling of lack of air, panic grows;
  • heart rate is accelerated, arrhythmia is possible;
  • because of lack of air, veins swell in the neck;
  • is a characteristic symptom - the patient accepts a forced position. As a rule, he lays down on the side, afflicted with pleurisy;
  • in the congestion zone of the effusion is clearly visualized by the ribs.

If at this point the patient is examined by a doctor, then during auscultation of the localization zone of the hydrothorax he will hear a complete absence of respiratory noises. Also, percussion in the lower section of the affected lung will be marked by dullness of the sound.

The most dangerous symptom is the movement of the heart to a healthy side. This occurs with a large accumulation of effusion. If this happens, then an excess of the inferior vena cava that supplies blood to the heart is possible. As a consequence, his blood supply will be disrupted.

All these symptoms are important to know, as the disease can develop rapidly and from the timely contact with a doctor can depend not only on the preservation of human health, but even his life.

Phases

In medicine, three phases of development of the disease are clearly marked:

  • phase of exudation. Its total duration does not exceed three weeks. During this time interval, a gradual accumulation of effusion occurs in the pleural cavity. According to some reports( doctors' testimonies, patient's medical history), it was revealed that during this period the volume of liquid can reach 10 liters! Symptoms of exudative pleurisy at this stage are fairly vivid;
  • stabilization phase. It is characterized by the suspension of the formation of effusion, but its adsorption has not yet begun. Symptoms become less pronounced, and the clinical picture stabilizes;
  • phase of resorption. Time indicator - a maximum of three weeks. At this time, there is a resorption of the exudate and the formation of the moss.

Diagnosis

If the first symptoms of the development of the hydrothorax are detected, it is recommended that they urgently go to a medical facility to diagnose and identify the cause of the disease.

Informative Diagnostic Techniques:

  • physical. When it is held, doctors note the lag of the affected side of the chest with the act of breathing, its weakening, blunting of percussion sound during percussion, noise of splashing during auscultation;
  • X-ray examination( a technique for diagnosing hydrothorax of any etiology, including tuberculosis).In the lower parts of the lungs there is a significant dimming;
  • ultrasound of the pleural cavity;
  • thoracocentesis. This procedure is performed by the entire patient with suspected exudative pleurisy. During the procedure, doctors receive some of the effusion, which is then used for cytological, bacteriological and biochemical research;
  • thoracoscopy;
  • computed tomography of the lungs;
  • biochemical blood test.

All the data received without fail must be recorded by the doctor in the patient's medical history. All subsequent analyzes are also added there to monitor the dynamics.

Treatment of

Treatment of exudative pleurisy is primarily aimed at evacuating accumulated effusion from the pleural cavity, as well as treating the underlying disease that provoked hydrothorax.

If a significant amount of effusion has accumulated in the pleural cavity, the cavity is drained in an emergency manner. During this surgical procedure, the fluid is completely removed from the pleura. After the procedure, a number of symptoms disappear or decrease, including shortness of breath, body temperature, swelling of the cervical veins and so on.

Removal of fluid from the pleural cavity of

In view of the main diagnosis recorded in the medical history, drug therapy is prescribed:

  • in exudative pleurisy of tuberculosis etiology shows tuberculostatic therapy;
  • antibacterial therapy;
  • cytostatic;
  • hormone therapy( appointment of glucocorticoids).

The second stage is symptomatic treatment. The doctor prescribes drugs whose action is aimed at reducing the severity of symptoms:

  • antitussive;
  • analgesics;
  • NPP;
  • diuretics;
  • desensitizing.

Dosages of prescribed synthetic medications are recorded in the medical history.

Also good effect gives physiotherapy treatment. If there are no specific contraindications, then paraffin therapy and electrophoresis are prescribed.

Prevention

Prevention of hydrothorax, first of all, is to prevent and timely treatment of diseases that can affect the pleura. It is also worthwhile to work on strengthening your immune system.

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If you think that you have Exudative pleurisy( hydrothorax) and symptoms typical for this disease, then doctors can help you: pulmonologist, thoracic surgeon.

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