Hydrothorax

Description:

Hydrothorax is called accumulation in pleural polosyotyakh of transudate, i.e. an exudate of a noninflammatory origin. Pathological processes, privoyodyashchy to increase in a ratio between a hydrostatic davyoleniye in capillaries and the colloid osmotic pressure of a blood plasma are the cornerstone of transudation. If hydrostatic pressure in pleural capillaries begins to exceed colloid осмо­тическое plasma pressure, comes to the propotevayena otnositelyyono of liquid poor in protein through not changed capillary wall and its accumulation in a pleural cavity.

Hydrothorax symptoms:

Clinical manifestations of a hydrothorax usually supplement and make heavier manifestations of a basic disease. At znachitelyyony accumulation of transudate an asthma usually arises or amplifies, the feeling of weight in the corresponding half of a breast appears. The patient aims to accept forced situation with the raised upper part of a trunk and with an inclination towards transudate accumulation. Fnzikalny and rentgenologiyochesky symptoms are similar to signs of accumulation of liquid at exudative pleurisy.

At a trial puncture receive almost transparent zhidyokost of light-straw color giving a negative reakyotion of Rivalt with the specific weight less than 1015 and protein content less than 30 g/l (in inflammatory exudate sootvetstyovuyushchy indicators are represented by higher). The deposit is poor in cells among which the slushchepny mesothelium prevails.

Hydrothorax reasons:

Most often congestive seryodechny insufficiency of various origin (dekompen-sirovanny heart diseases, the squeezing pericardis, the porazheyoniya of a cardiac muscle) leading to increase in vnutrikapnllyarny hydrostatic pressure, and in far come cases and to the hypoproteinemia reducing a colloid and osmotic davyoleniye of plasma is the reason of a hydrothorax. Besides, to transudation in a pleural poyolost the diseases which are characterized by a vyrazhenyony hypoproteinemia, for example damages of kidneys, сопровож­дающиеся a considerable albuminuria, the liver diseases causing disturbances of synthesis of protein (for example, цир­роз), etc. can lead. Some authors find possible a proniknoyoveniye from an abdominal cavity in pleural an ascitic zhidyokost at cirrhosis (through minor defects and limfaticheyosky ways of a diaphragm). The hydrothorax at a myxedema is described, and also at some forms of fibromas of ovaries (a so-called syndrome of Meygs). Emergence of transudation in the latter case did not find a satisfactory objyoyasneniye yet.

Small on transsudata volume significantly do not otrazhayotsya on a current and manifestations of a basic disease. At a nayokopleniya of a significant amount of liquid disorders of breath and blood circulation, svyayozanny with a compression of lungs and sdavlenny or the shift of oreganos of a mediastinum come or are aggravated. Though theoretically conditions for transudation in both pleural cavities are represented identical, more often the right-hand hydrothorax is observed in the beginning, kotoyory further can become bilateral. The partial or full obliteration of a pleural cavity limits or iskyolyuchat transudation with corresponding the parties.

Treatment of the Hydrothorax:

The hydrothorax moderated on volume usually does not treyobut special medical events and rezorbirutsya, as a rule, at successful treatment of a basic disease (a napriyomer, heart failure). At the considerable accumulation of transudate conducting to the expressed functional rasyostroystvo the puncture with aspiration of liquid from a plevyoralny cavity which at massive it is long a sushchestvoyovavshy hydrothorax (more than 1,5-2 l) is shown it is recommended осущест­влять in two steps as elimination of a compression ateyolektaz comes not at once, and in I will shift bystry movement of a mediastinum from where the exudate was evacuated, sometimes it pereyonositsya badly by patients.

It is necessary to use all opportunities of conservative treatment of a basic disease (cordial and diuretics, intravenous nnfuziya of proteinaceous drugs etc.) to avoid frequent repeated punctures with transudate evacuation" as the last lead to considerable loss of protein and usugubyolyat a ginoproteinemiya therefore can сформировать­ся a vicious circle.