Hydrothorax: causes, pathologies, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 29, 2022

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The term hydrothorax refers to a clinical condition characterised by the pathological collection of serous (non-inflammatory) fluid that accumulates in the pleural cavity

Causes and pathologies related to hydrothorax

Generalised oedema.

Usually associated with dysproteinaemia.

Abnormalities in protein synthesis may in turn be due to malabsorption and/or malnutrition, hepatopathy or nephropathy.

Circulatory stasis. Typical circumstances in which stasis may occur are heart failure, kidney and liver disease.

Increased venous or lymphatic pressure. Usually related to compression of large veins or thoracic lymphatic vessels by mediastinal growth tumour masses.

Hepatic hydrothorax is an extremely common occurrence of hydrothorax and occurs in individuals with decompensated cirrhosis of the liver.

The pleural effusion in this case originates from the ascitic effusion itself and is found in about 5 per cent of subjects with liver cirrhosis and ascites.

In the vast majority of cases, the effusion is on the right side.

In addition to the mechanisms listed above, this type of hydrothorax would also be favoured by the presence of small continuous solutions in the diaphragm muscle, particularly in its tendinous portion.

The hydrothorax from a symptomatological point of view may be completely silent

If it becomes conspicuous in size, it may result in compression of the thoracic organs (in particular the heart, lungs and large vessels), leading to

General malaise
Inappetence
Dyspnoea (difficulty breathing)
Tachycardia (increased heart rate)
Chest pain or tightness
Cyanosis
Lipotimia (fainting).

Diagnosis

The diagnostic suspicion is initially clinical and is based on a careful anamnestic collection and the symptoms reported by the patient.

Additional instrumental examinations that can be performed as confirmatory tests are:

The chest X-ray
Chest computed tomography
Respiratory function tests
Differential diagnosis, hydrothorax must be distinguished from:
Haemothorax (pleural effusion consists of blood; usually related to major trauma).
Empyema (effusion consists of a collection of pus; usually associated with infectious processes of the chest).
Chylothorax (effusion of chyle, i.e. lymphatic fluid, from thoracic duct rupture).

Treatment

The treatment of hydrothorax can be particularly complex.

Therapy must primarily be directed at treating the underlying causes of the condition, i.e. those causes that originated the problem.

Diuretic therapy is extremely valuable in many cases of hydrothorax, and particularly in controlling pleural and ascitic effusion in those subjects with hepatic hydrothorax.

In subjects who, despite diuretic therapy, remain symptomatic and in particular present dyspnoea at rest or on exertion, it may be necessary to evacuate the effusion by thoracentesis.

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