Exudative pleurisy (hydrothorax): symptoms and treatment

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 disease 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.



Exudative pleurisy is difficult to call 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 exudate 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.

Mechanism

Hydrothorax affects only 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. The 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

Hydrothorax 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
  • The nature of the effusion is distinguished: serous, serous-purulent (exudate of pus), purulent, cholesterol and hemorrhagic (the most dangerous)
  • Depending on the anatomical form: local (which is also subdivided into the parietal, apical, diaphragmatic, etc.) and diffuse.

Reasons

A common cause of the 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 is 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:


  1. Mycobacterium tuberculosis (promote the development of hydrothorax tuberculosis etiology)
  2. Staphylococci
  3. Pneumococci
  4. Streptococci
  5. Hemophilus influenzae;
  6. Pseudomonas aeruginosa
  7. brucella;
  8. viruses;
  9. Echinococci
  10. fungi
  11. Protozoa.

Separately, it is worth mentioning hydrothorax tuberculosis etiology . Its main cause of development is an increase in the sensitivity of the patient’s body to the stick of Koch. This process in medical circles is called «sensitization». As a result, if a few microbes enter the cavity of the pleura, the reactive effusion will begin to accumulate several times faster. And in this situation, this is a serious complication, which can lead to death. Tuberculosis hydrothorax affects mostly adults only, almost without affecting children.

The main reasons for the development of non-infectious exudative pleurisy:


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

Symptoms

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


  1. the severity of the pathology (especially severe hydrothorax tubercular etiology)
  2. 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;
  • the severity of the lesion localization is felt
  • There may be a feeling of lack of air, panic grows
  • heart rate is accelerated, arrhythmia is possible;
  • due to lack of air, veins swell in the neck area
  • a characteristic symptom — the patient takes a forced position. As a rule, he lies on the side affected by pleurisy
  • the ribs are clearly visualized in the congestion zone of the effusion

If at this moment 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 dulling of the sound.

The most dangerous symptom is moving 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 is impaired.

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




Phases

In medicine, clearly defined three phases of the development of the disease:


  1. 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 found that during this period the volume of liquid can reach 10 liters! Symptoms of exudative pleurisy at this stage are clearly expressed;
  2. stabilization phase. It is characterized by the suspension of effusion formation, but its adsorption has not yet begun. Symptoms become less pronounced, and the clinical picture stabilizes;
  3. phase of resorption. The time period is a maximum of three weeks. At this time, there is a resorption of the exudate and the formation of schwartes.

Diagnostics

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

Informative Diagnostic Techniques:


  • Physical. When it is held, doctors note the lag of the affected side of the chest at the act of breathing, its weakening, dullness of percussion sound with percussion, splash noise 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 darkening;
  • Ultrasonic 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 studies;
  • Thoracoscopy
  • computed tomography of the lungs
  • Biochemical blood test.

All the data received, without fail, the doctor records in the patient’s medical history. All subsequent analyzes are also added there to monitor the dynamics.

Treatment

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

If a significant amount of effusion accumulates 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, etc.

Taking into account the main diagnosis recorded in the medical history, drug therapy is prescribed:


  1. tuberculostatic therapy is indicated in exudative pleurisy of tuberculosis etiology
  2. antibacterial therapy
  3. cytostatic;
  4. hormone therapy (administration of glucocorticoids).

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


  • antitussives
  • analgesics
  • NPP
  • diuretics
  • desensitizing.

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

Also a 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.