Hydrothorax

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Chapter 407 Hydrothorax

Glenna B. Winnie, Steven V. Lossef

Hydrothorax is a transudative pleural effusion usually caused by abnormal pressure gradients in the lung.

Etiology

Hydrothorax is most often associated with cardiac, renal, or hepatic disease. It can also be a manifestation of severe nutritional edema and hypoalbuminemia. Rarely, it results from vascular obstruction by neoplasms, enlarged lymph nodes, pulmonary embolism, or adhesions. It may occur from a ventriculoperitoneal shunt or peritoneal dialysis and has been reported in congenital parvovirus B19 infection.

Clinical Manifestations

Hydrothorax is usually bilateral, but in cardiac disease it can be limited to the right side or greater on the right than on the left side. The physical signs are the same as those described for serofibrinous pleurisy (Chapter 404.2), but in hydrothorax, there is more rapid shifting of the level of dullness with changes of position. It is usually associated with an accumulation of fluid in other parts of the body.

Laboratory Findings

The fluid is noninflammatory, has few cells, and has a lower specific gravity (<1.015) than that of a serofibrinous exudate. The ratio of pleural fluid to serum total protein is <0.5, the ratio of pleural fluid to serum lactic dehydrogenase is <0.6, and the pleural fluid lactic dehydrogenase value is less than 66% of the upper limit of the normal serum lactic dehydrogenase range.

Treatment

Therapy is directed at the underlying disorder; aspiration may be necessary when pressure symptoms are notable.

Born M, Reichling S, Schirrmeister J. Pleural effusion: beta-trace protein in diagnosing ventriculoperitoneal shunt complications. J Child Neurol. 2008;23:810-812.

Kosiak M, Korbus-Kosiak A, Kosiak W, et al. Is chest sonography a breakthrough in the diagnosis of pulmonary thromboembolism in children? Pediatr Pulmonol. 2008;43:1183-1187.

Krishnan RG. Acute hydrothorax complicating peritoneal dialysis. Perit Dial Int. 2007;27:296-299.

Sarafidis K, Drossou-Agakidou V, Evdoridou I, et al. Hydrothorax as a sole manifestation of congenital parvovirus B19 infection. Am J Perinatol. 2008;25:551-554.

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