What is a hydrothorax?
Medical Definition of hydrothorax : an excess of serous fluid in the pleural cavity especially : an effusion resulting from failing circulation (as in heart disease or from lung infection)
What are the treatment options for hydrothorax?
Management of hydrothorax is particularly challenging in individuals for whom TIPS is contraindicated and in those whose hydrothorax is refractory to TIPS. One therapy used for refractory hydrothorax is tunneled pleural catheters (Harris & Chalhoub, 2012), which are used for the management of refractory malignant effusions.
What is the pathophysiology of hepatic hydrothorax?
Hepatic hydrothorax is defined as the presence of a significant pleural effusion in the absence of a primary cardiac or pulmonary cause218,219 and has a 5% incidence in cirrhosis. 220 The effusion most commonly occurs on the right side (85.4%). 220 Clinical presentation varies from an asymptomatic finding to severe respiratory distress.
What causes hydrothorax in heart failure?
Hydrothorax. Hydrothorax is a type of pleural effusion in which transudate accumulates in the pleural cavity. This condition is most likely to develop secondary to congestive heart failure, following an increase in hydrostatic pressure within the lungs. More rarely, hydrothorax can develop in patients with cirrhosis or ascites.
What do you mean by hydrothorax?
Hydrothorax is a noninflammatory collection of serous fluid within the pleural cavities. The effusion is clear and straw colored. Hydrothorax is unilateral or bilateral. The most common cause of hydrothorax is cardiac failure, but it is also frequently the result of renal failure and cirrhosis of the liver.
What is hydrothorax vs pleural effusion?
Hydrothorax is a type of pleural effusion in which transudate accumulates in the pleural cavity. This condition is most likely to develop secondary to congestive heart failure, following an increase in hydrostatic pressure within the lungs....HydrothoraxSpecialtyRespirology1 more row
What are the signs symptoms of hydrothorax?
Symptoms and CausesChest pain.Dry, nonproductive cough.Dyspnea (shortness of breath, or difficult, labored breathing)Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)
What is hydrothorax and pneumothorax?
A hydropneumothorax (plural: hydropneumothoraces) (or less commonly pneumohydrothorax (plural: pneumohydrothoraces)) is the term given to the concurrent presence of a pneumothorax and pleural effusion (i.e. hydrothorax) (i.e. gas and fluid) in the pleural space.
What causes hydrothorax?
The most common cause of hydrothorax is cardiac failure, but it is also frequently the result of renal failure and cirrhosis of the liver. Hemothorax represents escape of blood into the pleural cavity and may represent a fatal complication of a ruptured aortic aneurysm or vascular trauma.
How does hydrothorax occur?
Hepatic hydrothorax is thought to result from passage of ascitic fluid from the peritoneal cavity into the pleural spaces (typically on the right in up to 85% of patients) via subcentimeter defects and/or microscopic fenestrations in the tendinous portion of the diaphragm and is facilitated by negative intrathoracic ...
How do you treat Hydrothorax?
The definitive treatment is liver transplantation (8), but many patients are not candidates for this treatment. The next best treatment of hepatic hydrothorax is to implant a transjugular intrahepatic portal systemic shunt (TIPS) (9).
How is Hydropneumothorax treated?
Treatment options may include observation, needle aspiration, chest tube insertion, nonsurgical repair or surgery. You may receive supplemental oxygen therapy to speed air reabsorption and lung expansion.
What is hepatic Hydrothorax?
Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis who does not have other reasons to have a pleural effusion (eg, cardiac, pulmonary, or pleural disease) [1-3]. Hepatic hydrothorax occurs in approximately 5 to 15 percent of patients with cirrhosis.
What causes hydropneumothorax?
A pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures, or damage from underlying lung disease. Or it may occur for no obvious reason. Symptoms usually include sudden chest pain and shortness of breath. On some occasions, a collapsed lung can be a life-threatening event.
What is the difference between pneumothorax and hydropneumothorax?
Hydropneumothorax is a rare variant type of a pneumothorax. It consists of both free fluid and air within the pleural space. In the pediatric population, hydropneumothorax has been associated with rupture of a diaphragmatic hernia, after thoracocentesis, and trauma and with infections such as tuberculosis [1, 7, 8].
What is the difference between pneumothorax and hemothorax?
Pneumothorax, which is also known as a collapsed lung, happens when there is air outside the lung, in the space between the lung and the chest cavity. Hemothorax occurs when there is blood in that same space.
Where is the needle inserted in a thoracentesis?
In a thoracentesis, a needle is inserted through the back of the chest wall in the sixth, seventh, or eighth intercostal space on the midaxillary line, into the pleural space. The use of ultrasound to guide the procedure is now standard of care as it increases accuracy and decreases complications.
How long does a pleural tube stay in?
For patients with malignant pleural effusions, it allows them to continue chemotherapy, if indicated. Generally, the tube is in for about 30 days and then it is removed when the space undergoes a spontaneous pleurodesis.
What causes a transudative pleural effusion?
The most common causes of transudative pleural effusion in the United States are heart failure and cirrhosis. Nephrotic syndrome, leading to the loss of large amounts of albumin in urine and resultant low albumin levels in the blood and reduced colloid osmotic pressure, is another less common cause of pleural effusion.
Where is pleural fluid secreted?
Pleural fluid is secreted by the parietal layer of the pleura and reabsorbed by the lymphatics in the most dependent parts of the parietal pleura, primarily the diaphragmatic and mediastinal regions . Exudative pleural effusions occur when the pleura is damaged, e.g., by trauma, infection or malignancy, and transudative pleural effusions develop when there is either excessive production of pleural fluid or the resorption capacity is reduced.
What is the arrow on an X-ray of a pleural effusion?
Pleural effusion Anteroposterior Chest X-ray of a pleural effusion. The A arrow shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity
What is hydrothorax in PD?
Hydrothorax. Hydrothorax is defined as the presence of excess fluid in the pleural cavity. The incidence of hydrothorax varies between 1.6-10% in PD patients, but predominantly in females.
What is the persistence of hydrothorax?
The persistence of hydrothorax requires permanent obliteration of the pleuro-peritoneal communication with pleurodesis using autologous blood, talc, tetracycline, surgical or thoracoscopic correction or video-assisted thoracoscopic (VATS) talc pleurodesis (1,3).
Is hydrothorax asymptomatic?
Diagnosis. Hydrothorax can be asymptomatic in about 25% of patients and is sometimes diagnosed as an incidental finding on routine physical examination ( 1,5). The most common signs and symptoms are dyspnea and inadequate ultrafiltration.
What causes a hemothorax?
Other possible causes of hemothorax include: 1 blood not clotting properly and leaking into the chest cavity 2 cancer in the lungs 3 fluid and cancer around the lungs, called malignant pleural effusion 4 cancerous tumors in your chest wall 5 large vein torn open when a catheter is inserted while you’re in the hospital 6 tissue around your lungs dying, called pulmonary infarction 7 Ehlers-Danlos syndrome (EDS) type 4, a condition that affects your connective tissues
Why does hemothrax happen?
Hemothorax also commonly happens as a complication of a major heart or lung surgery that requires a surgeon to open the chest wall. Blood can leak into the chest cavity if the blood doesn’t clot properly after the surgeon closes the incisions, or if an organ or vessel is cut open and leaks blood.
Why does my chest pool?
The pooling of blood in your chest can have numerous causes. It’s most common after major chest injuries or surgeries that include opening your chest wall, especially heart or lung surgery. Certain conditions that cause your blood not to clot properly can also cause hemothorax.
What is the term for the tissue around the lungs that dies?
tissue around your lungs dying, called pulmonary infarction. Ehlers-Danlos syndrome (EDS) type 4, a condition that affects your connective tissues. In rare cases, especially outside of the United States and other developed countries, hemothorax can be caused by tuberculosis (TB).
How do you know if you have hemothorax?
The most common symptoms of hemothorax include: pain or feeling of heaviness in your chest. feeling anxious or nervous. dyspnea, or having trouble breathing. breathing quickly. abnormally fast heartbeat. breaking out in cold sweats. skin turning pale. high fever over 100°F (38°C)
What is the procedure for a bleed in the chest?
If the bleeding continues even as the tube drains the blood, you may need chest surgery to treat the cause of the bleeding. Chest surgery is also known as thoracotomy. The type of thoracotomy needed is based on which part of your chest or organs your surgeon needs to operate on.
What do you do when you have a hemothorax?
If you go to the emergency room for hemothorax, your doctor or emergency medical staff will use emergency tools, such as a ventilator with a tube inserted through your nose into your windpipe, to support your breathing and make sure you’re getting enough oxygen . The most important treatment for hemothorax is draining the blood out ...
Symptoms
The condition does not have symptoms specific to it because it generally occurs with ascites and other manifestations of portal hypertension caused by liver disease. The main symptoms are usually related to liver cirrhosis and ascites. Less commonly, the condition may be the sole manifestation of chronic liver disease.
Mechanism
Although there is no exact, well-defined mechanism for this condition, several mechanisms have been proposed, including low albumin levels in blood reducing the osmotic pressure and increasing the pressure in the azygos vein, resulting it to leak plasma into the pleural cavity.
Diagnosis
The diagnosis is based on the existence of liver cirrhosis, the lack of any primary pleural, cardiac, or pulmonary disease, and finding pleuroperitoneal communications. Analyzing the pleural fluid is done to identify the fluid, and to rule out other possible caused like infection or cancer.
Management
Management is focused on treating and preventing the relapse of ascites, as the main mechanism of the condition is ascitic fluid flowing through the diaphragm. Some cases respond to medical management. In up to 26% of cases, the condition does not respond to medical management, in which case it is known as a refractory hepatic hydrothorax.
Prognosis
The prognosis is poor and the mortality rate is high. The median survival time for cases with this condition is 8–12 months.
Epidemiology
The condition is found in 5-10% of cirrhosis cases and 2-3% of all pleural effusions.
Pathophysiology
- Hepatic hydrothorax occurs in approximately 5% of patients with liver cirrhosis and portal hypertension. Pleural effusions accumulate from transdiaphragmatic migration of ascitic fluid. Fluid also accumulates from the decreased oncotic pressure associated with secondary hypoal…
Signs and symptoms
- Hepatic hydrothorax is defined as the accumulation of fluid in the pleural space as a consequence of liver disease.98 The most common symptom is dyspnea without chest pain. It can be detected with chest radiographs in as many as 13% of patients with cirrhosis.99 Right-sided pleural effusion is seen in 66% of the patients with hepatic hydrothorax.
Management
- The management options for hepatic hydrothorax include medical management of ascites and therapeutic paracentesis for the control of shortness of breath.98,99 Pleurodesis of the pleural space with chemical means such as talc, antibiotics, or chemotherapeutic agents usually fails.99 TIPS has been successfully used to manage the symptoms of hepatic hydrothorax in the settin…
Results
- TIPS is physiologically equivalent to a side-to-side portocaval shunt that is placed by an interventional radiologist.103 The results from the North American Study for the Treatment of Refractory Ascites (NASTRA) showed that TIPS is substantially superior to conventional medical therapy but does not improve the survival or quality of life.104 A recent meta-analysis confirms t…
Epidemiology
- The incidence of hydrothorax in patients receiving PD has been reported to be 2%.59 Similar to hernias, it has also been speculated that this figure is an underrepresentation of the true incidence of hydrothorax as the result of asymptomatic cases.60 Women are also more likely than men to develop hydrothorax. The reason for this sexual predominance is unknown, although stretching …
Risks
- Multiple risk factors for the development of hydrothorax in PD patients have been described in the literature.52,53,55,56,59,61,62 However, it is interesting to note that in most cases of hydrothorax a risk factor is not identified.14,59,63,64
Clinical significance
- Polycystic kidney disease (PCKD) has been consistently associated with hydrothorax formation.61 Two potential explanations for this correlation are 1) the polycystic kidneys compound the rise in IAP when dialysate is infused into the peritoneal cavity, and 2) there is a greater inherent weakness of the diaphragm as a part of a generalized connective tissue defect …
Diagnosis
- The diagnosis of hepatic hydrothorax is usually easily established from the clinical picture. If doubt exists, the diagnosis can be confirmed by scanning the chest after 99mTc sulfur colloid is injected into the peritoneal cavity.171 Both a paracentesis and a thoracentesis should be performed to confirm that the ascites and pleural fluid are both transudates. Xiol and associates…
Treatment
- The initial management of the pleural effusion associated with cirrhosis and ascites should be directed toward treatment of the ascites. Chest tube insertion should be avoided because the ascitic fluid will also drain through the chest tube, which can lead to significant fluid and protein losses and even fatal cardiovascular collapse.168 Instead, the patient should be given a low-sal…