Error in determining hydrothorax in the fetus. Hydrothorax: an alarming symptom

Fetal hydrothorax is a rare pathology of the perinatal period. It occurs in 1 case in 10 to 15,000 pregnancies. As a rule, this pathology is diagnosed in the second trimester of pregnancy.

For almost 30 years, 628 cases of fetal hydrothorax have been described in the world literature.

However, in the Medical Genetic Center of St. Petersburg in 2007 alone, among all the prenatal genetic examinations, fetal hydrothorax was found in 20 cases. Most often it was accompanied by general dropsy of the fetus and hygroma of the neck, including, in 3 cases, the 45-X chromosome of the Turner type (partial trisomy) was detected.

We present 2 cases of fetal hydrothorax, which were characterized by a similar morphological picture.

Observation number 1: a fetus born at 38 weeks of gestation from the first pregnancy, a 19-year-old mother, weighing 3880 g, died intrapartum.

The woman was followed up in the antenatal clinic from 32 weeks of pregnancy. Ultrasound in the right lung revealed a two-chambered hollow mass containing fluid, displacing the heart to the left, which increased by 37 weeks to 9x8x5 cm. IN abdominal cavity there was fluid, there was also edema of the soft tissues of the fetus.

Study of the placenta:

Placenta weighing 640 grams. The placental-fetal index was 0.16. The tissue of the placenta on the cut is dark red, the membranes are pale pink, thin, shiny.

Microscopic examination in the placenta was noted pronounced delay maturation of villi, focal horangiomatosis. A capillary hemangioma was found in the umbilical cord.

At the autopsy, attention was drawn to the pallor and pastiness of the skin of the fetus, the subcutaneous fat on the front surface of the chest and abdomen was sharply edematous (translucent, greenish), more than 1 cm thick.

The pleural cavities on the right and on the left contained about 100 ml of clear fluid, the lungs were collapsed, pressed to the root. The right lung is not completely divided into lobes; on the cut, the lung tissue is homogeneous, leathery, bluish-red.

The thymus is reduced in size, weighing 6, 4 g (in N \u003d 10 g), gray-pink in color, with a dense consistency, multiple small hemorrhages are visible under the capsule.

The heart is enlarged, its weight is 16.4 g (in N \u003d 10 g), the endocardium of the outlet of the left ventricle is whitish, dense; shortening of the main trunk is noted pulmonary artery (1.0 cm) and moderate narrowing of the aortic opening (perimeter 1.5 cm, in N \u003d 2.5 cm).

Observation No. 2: a fetus born at the 27th week of the 1st pregnancy, mothers 22 years old, weighing 1000 g, ultrasound revealed bilateral hydrothorax at 21 weeks of gestation, accompanied by a hygroma of the neck.

Study of the placenta:

The placenta weighing 140 g, the placental-fetal index 0.14, the tissue of the placenta on the cut is gray-pink, the membranes are gray-pink, thin.

Microscopic examination in the placenta showed a violation of branching and maturation of villi and trophoblastic invaginates in the stroma of the villi, which is characteristic of chromosomal pathology.

At the autopsy, attention was drawn to a short, thickened neck, swelling of soft tissues. In the serous pleural cavities there is an accumulation of clear yellowish fluid: on the right - 30 ml, on the left - 50 ml.

The lungs are drawn to the root. The brain is flabby, the lateral ventricles are moderately dilated, filled with liquid blood. Vascular plexuses are dark red. There is liquid blood in the cerebrospinal fluid. Thymus is small in size, weighing 1.4 g, gray-pink, flabby consistency.

In both cases, for histological examination internal organs in the lungs, a similar morphological picture was noted, which corresponded to the descriptions of fetal hydrothorax in the world literature (E. Poer, 1996; Karoll, 1987; Woller, 2000; Longaker, 1977). It consisted in the following: the lymphatic vessels in the pleura were dilated, forming large cavities. Large cavities (such as bullae) lined with endothelium, sometimes reaching the pleura, were also visible in the respiratory regions at the root of the lungs and on the periphery. There was also plethora, thickening of the walls blood vessels... In addition, there was a violation of the formation of small bronchi by the type of cystic dysplasia of the bronchi and widespread atelectasis. In the thymus, large cystic and petrified thymic bodies were found in the medulla layer of the lobules. In the brain, capillary hyperplasia with angiectasias was found.

Thus, in both cases, the revealed changes in the lungs (with ultrasound and morphological methods) made it possible to regard the pathology as fetal hydrothorax (congenital pulmonary dysplasia with lymphangiectasia and diffuse atelectasis). Bilateral nature of the lesion, the presence of polytissue pulmonary dysplasia (lymphangiectasia, atelectasis, bronchial dysplasia, thickened vessel walls), anasarca, hygroma, and also a combination in the first case with vascular malformations (large - pulmonary artery and aorta, small - cerebral vessels) and the nature of the changes in the thymus (large cystic dilated dehydrated thymic bodies) suggest a connection between fetal hydrothorax and chromosomal pathology (pathology of the 45-X chromosome).

According to the literature, bilateral fetal hydrothorax in 42% of cases was combined with pathology in the 45-X chromosome (Turner phenotype). In 90% of observations with this option, there is a fatal outcome in the last trimester of pregnancy.

In 34%, trisomy on chromosome 21 is observed. As a rule, fetal hydrothorax can also occur with trisomy 18 and 13 chromosomes and triploidy. The most common mechanism for the development of fetal hydrothorax is lymphatic obstruction.

Thus, fetal hydrothorax is often combined with dysplasia of the lymphatic vessels. In addition, congenital cystic lung malformation, diffuse atelectasis and hypoplasia of the lungs are common.

More on the topic Melnikova V.F., Chikulaeva E.V., Fedotova E.P. CASE STUDY: TWO CASES OF FETAL HYDROTORAX:

1. § 1. Statement of a general theoretical problem: the need to create a concept of Russian procedural proof and law enforcement

Congenital diaphragmatic hernia (EDC). EDH is an anatomically uncomplicated defect that can be corrected after birth. In this case, the hernial sac is removed from the chest cavity, and the diaphragmatic defect is sutured. However, despite the simplicity of the surgical technique, mortality among this category of patients remains high. Even in the case of using equipment for extracorporeal membrane oxygenation (EKMO) with EDH, which is diagnosed before 24 weeks of gestation, the death of newborns is 58-80%. It is associated with severe hypoplasia. lung tissue and pulmonary hypertension. This immaturity is reversible, despite the fact that it takes weeks, if not months. After birth, the time of Ekmo-support is limited to 1-2 weeks, respectively, patients with severe pulmonary hypoplasia are doomed. Therefore, in the last decade, intrauterine correction of the deficiency has found an increasing number of adherents. In numerous series on animals, it has been proven that a prenatally performed operation provides the necessary time for the growth and development of the pulmonary parenchyma, morphometric parameters that differ little from healthy tissue.

The presence of the left lobe of the liver in the chest cavity is the main technical obstacle to the correction of the defect, since its simple return to the abdominal cavity affects the blood circulation through the umbilical veins. At the dawn of fetal surgery, there was a popular so-called two-stage operation: removal of the prolapsing hepatic lobe, reconstruction of the diaphragm, and mechanical increase in the volume of the abdominal cavity after "repeated immersion of organs."

However, the subsequent occlusion of the ductus venosus, which was at first located above the diaphragm, forced to abandon this technique. Accordingly, the determination of the thoracic location of the liver part is the most important tactical moment. This is solved during either ultrasound with color mapping (assessment of blood flow through the umbilical veins and venous duct), or by scanning in the sagittal plane with an MRI scanner. The existing medical and diagnostic algorithm for EDH was developed by the staff of the Center for the Treatment of Fetal Defects at the University of California (San Francisco, USA).

If isolated EDH is detected before 24 weeks of gestation, family members are asked to choose from the following options:

2) give birth to a child on time and continue treatment in the intensive care unit (with an expected favorable prognosis of no more than 58%);

3) try to correct the developmental deficiency prenatally. The recommended algorithm and modern ultrasound parameters help to determine the treatment tactics.

In the case of the formation of EDH in late gestation, as well as with hypoplasia of the parenchyma of the lungs and minimally displaced organs of the mediastinum and stomach, it is optimal to carry out treatment after the birth of the child. Intrauterine correction is carried out in the presence of the following factors - early formation of EDH, significant displacement of the mediastinal organs, an enlarged stomach in the chest cavity, minimally visualized lung tissue, and polyhydramnios.

The search for new surgical approaches to the treatment of EDH ended with the development of a technique for temporary occlusion of the trachea (TLPR - pulmonary tamponade until full development). At the same time, due to the prevention of the physiological outflow of fluid from the airways of the fetus, the pressure in the lung tissue increases, which in turn contributes to the expansion of hypoplastic lungs and the return of organs to the abdominal cavity. Described cases of excessive proliferation of the pulmonary parenchyma beyond the diaphragm.

Against this background, the stimulation of trophic factors occurs simultaneously. Pulmonary mass increases due to direct hyperplasia, and not hypertrophy. LPR is performed in an open way and endoscopically, internally and extra-lumenally within 24-28 weeks. gestation. Provided different methods of tracheal occlusion - the introduction of an obstructing plug into the cavity, the application of a clip, the placement of a balloon and an umbrella, which change their volume during the growth of the fetus. The performed comparative analysis of different methods of EDH correction confirmed the high efficiency of TLPR. The use of a minimally invasive tracheal obturator placement technique reduces the risk of preterm labor, which is the Achilles heel of fetal surgery.

Obstruction urinary tract (Weapons of mass destruction). There are both one- and two-sided weapons of mass destruction. The localization level is different. In the first case, the prognosis is favorable for the postnatal functioning of not only the urinary system, but also the lungs. Bilateral OMP, especially in combination with oligohydramnios, often leads to the loss of the child in the immediate postnatal period. In boys, bilateral lesions are usually caused by a posterior urethral valve. For girls, a cloacal abnormality associated with chromosomal defects is characteristic. Damage to the renal parenchyma ranges from medium severity of hydronephrosis to severe dysplasia. There was a clear connection between OMP and lung development. Low water due to critically reduced urine output by the fetus initiates the processes of hypoplasia of the pulmonary parenchyma. Perinatal mortality due to renal failure, which develops against the background of the posterior urethral valve in the absence of intrauterine correction, reaches 50%. Ultrasound diagnostics in conjunction with biochemical studies of fetal urine allows formulating indications for fetal correction of the defect. Renal dysplasia is characterized by increased echogenicity, as well as numerous cysts in the cortical layer of the parenchyma. Renal failure appears high level the content of electrolytes and β 2 -microglobulin in urine. Approximately 75% of all fetuses with dilated urinary tract do not require intrauterine correction. The middle stage of bilateral hydronephrotic transformation of the kidneys without a decrease in the volume of amniotic fluid is corrected mainly after the birth of the child. However, the presence of a downward trend in both renal function and amniotic fluid volume is the rationale for intrauterine intervention. The main method of intrauterine decompression bladder there is a subcutaneous installation of a shunt under ultrasound guidance. If such an operation is necessary before 24 weeks of gestation, the cystostomy is performed by an open method, taking into account the increased risk of premature birth. The technique of fetoscopic transvesical laser dissection of the posterior urethral valves is of growing interest. A trocar with a thin endoscope, bypassing the wall of the uterus and the bladder, enters the lumen of the latter, which makes it possible to assess the condition of the mucous membrane, the place of confluence of the ureters, as well as the localization of the urethral valves. A timely performed operation aimed at unloading the urinary tract allows to prevent a decrease in the volume of amniotic fluid and irreversible pulmonary and renal hypoplasia.

Sacrococcygeal teratoma (CCT). CCT is a neoplasm that often occurs during the neonatal period, with a minimal risk of malignancy and a good prognosis. However, the occurrence of pathology in the early stages of gestation (18-20% of the total), especially in combination with generalized edema of the fetus, leads to its death. This is due to the development of heart failure against the background of arteriovenous shunting of the tumor. The accompanying mother's mirror syndrome is due to placentomegaly and the edema noted above. The goal of intrauterine correction, which is usually carried out at 28-31 weeks, is to stop arteriovenous shunting. During the operation, the directly concerned area is removed from the uterine cavity. After visualization and isolation of the vascular pedicle, a ligature is applied to it. The tumor is resected as much as possible. In the future, the mother is prescribed a constant intake of dexamethasone.

Removal of the CKT, which is comparable in size to the fetal head, provokes a rapid decrease in the size of the uterus. In this case, constant perfusion during the operation of warmed lactate Ringer allows maintaining a constant volume of amniotic fluid. A sharp change in the working conditions of the fetal heart dictates tight echographic control throughout the pregnancy. An alternative open method of ligation is fetoscopic coagulation of the feeding vessel. The final removal of the CCP is performed immediately after the birth of the child. Intrauterine operation leads to the disappearance of fetal edema, but its implementation against the background of placentomegaly and mirror syndrome, which has developed, casts doubt on the favorable prognosis.

Chorionangioma is another neoplasm that leads to generalized edema and heart failure of the fetus. Its large size (more than 5-7 cm) emphasizes arteriovenous shunting expressed in it. The purpose of intrauterine surgery is endoscopic coagulation of tumor vascular anastomoses. Completed removal of the latter is carried out as soon as possible after delivery.

Myelomeningocele. Neural tube defects are less and less common, which is associated with the developed method of early α-fetoprotein screening. Since this disease does not prematurely provide a threat to life, the decision of the issue of intrauterine correction of the defect is strongly associated with the risk of premature birth. However, the progress of fetal surgery makes it possible to constantly expand the range of care provided. Since with myelomeningocele, the severity neurological disorders depends, among other things, on the length of the mechanical trauma and the action of the aggressive amniotic environment on the structures of the spinal cord. The operation is carried out in the early stages of gestation (20-23 weeks of intrauterine development), since early correction of the defect increases the chance of adequate spinal cord function. Surgical intervention performed both open and endoscopically. In the first case, the surgical technique does not differ from that after the birth of the child. During fetoscopic correction, the closure of the spinal cord defect is performed using alogen bone paste.

Stenosis of Sylvie's aqueduct. Obstruction of the outflow of cerebrospinal fluid leads to expansion of the ventricles, compression of the structures of the brain and further manifestation neurological disorders... If negative dynamics is observed already in utero, early ventricular decompression allows you to bypass the disorders characteristic of hydrocephalus. Fetal correction consists in the subcutaneous placement of a ventriculoamniotic shunt.

Heart block. Most fetuses with a correctly formed heart, but gradually progressive total heart block against the background of collagen vascular disease in the mother are born without the need for intrauterine correction. However, in a small part, due to bradycardia (heart rate less than 50 per minute), the development of generalized edema with loss of the fetus is possible. In case of ineffectiveness of β-adrenergic receptor antagonists and steroids, intrauterine implantation of a pacemaker is performed (open or endoscopic).

Pulmonary artery or aortic stenosis. Diagnosis of this deficiency does not provide for difficulties for echography. The content of the operation is to remove an obstacle to the flow of blood through the aortic or pulmonary valve. This is done by subcutaneous balloon dilatation of the narrowing site.

Tracheal stenosis or atresia. In a fetus with congenital obstruction of the upper respiratory tract syndrome, large, but ineffective lungs are found. This is due to their overstretching due to the fluid that has collected in respiratory tract... In this case, intrauterine tracheostomy is performed as the first stage in the treatment of developmental defects.

Facial skull deficiencies... It has been proven that wound healing during pregnancy occurs without scar formation. The development of fetal technologies allows taking full advantage of this feature of the fetus. Correction of the cleft palate and cleft lip (defects that are common after birth) are not always accompanied by a satisfactory cosmetic effect. Intrauterine correction of these defects allows you to avoid scarring, violation of the formation of the facial part of the skull and nasal cavity. The results obtained can be regarded as an example for all cosmetic surgery.

Amniotic constriction syndrome (GLANDERS). FAP is a whole group of fetal malformations, which are accompanied by amniotic constrictions. Early elimination of their contraction effect allows eliminating limb dysfunctions of different severity, as well as their possible intrauterine amputation. The diagnosis is established by conventional ultrasound. The operation is performed fetoscopically at 21-24 weeks of gestation. During such an operation, it is usually sufficient to coagulate and cross the existing cord. At the same time, a visual diagnosis of possible concomitant malformations is carried out. Restoration of blood supply to the extremities is carried out immediately at the stage of completion of the operation. In this case, it is necessary to check full recovery her functional ability.

Feto-fetal transfusion syndrome (FFTS) and fetal acardia-acephaly syndrome (FSAA)). In a small percentage of cases during pregnancy with twins, pathological common chorionic vessels may be in the placenta. Perinatal mortality with FFTS and FSAA reaches 75%. The exclusion of these vessels from the general blood flow is the goal of intrauterine surgery, which is performed subcutaneously under the control of echography, endoscopic or open method.

Over the past 20 years, there has been a review of approaches to the treatment of many diseases of newborns that were incurable. The development of high diagnostic and surgical technologies, the improvement of the technique of managing pregnant women opens up new opportunities for providing assistance to a child even at the stage of intrauterine development. The further path of fetal surgery is seen in the development and introduction of minimally invasive technologies, the spread of the spectrum of treatment of diseases and, as a result, distribution to narrow-profile areas (thoracic surgery, neurosurgery, etc.), similar to those observed in pediatric surgery.

Hello Almast.

Causes and symptoms

Pregnancy is one of the happiest times in a woman's life. Sometimes, unfortunately, it happens that such happy moments are overshadowed by sudden problems. An ultrasound diagnosis is just such a problem, because the disease is quite serious, insidious and quite realistically threatens not only the baby's health, but also his future life.

I want to note right away that the disease is quite rare, and most pregnant women do not even suspect that such a danger really exists at all. It is known that this diagnosis is made more often in boys than in girls. What caused this pattern is not fully known, but it really exists.

The exact cause of the development of hydrothorax is also not known for certain. Despite the fact that most experts are inclined to blame congenital heart problems for everything, it is certainly impossible to say this in your case in any case. By the way, already born babies can be diagnosed with hydrothorax if there has been an entanglement with the umbilical cord or birth trauma.

By the way, it is incorrect to believe that hydrothorax is a liquid in the baby's lungs. Rather, it is caused by the accumulation of fluid in the pleural cavities of the lungs (outer lung cavities). This fluid enters the cavity from the peritoneum and most often through small holes in the diaphragm. The people call the disease "dropsy of the chest."

Despite the fact that hydrothorax may turn out to be bilateral, it is the right-sided hydrothorax that is put on you first, which means the accumulation of fluid in pleural cavity right lung. In both cases, there can be a lot of fluid, so it is a mistake to believe that there are less risks with unilateral hydrothorax than with bilateral. A child with this disease is much more comfortable to be constantly in an upright position, because this is how he gets the opportunity to breathe normally.

Identification and treatment

The main danger of the disease is due to the difficulty of diagnostic measures. In most cases, it is detected even during the first ultrasound examinations or using a Doppler. If the baby has already been born and there are real prerequisites to believe that the pleural cavities of his lungs are filled with water (the child has constant shortness of breath, turn blue skin on the face), the doctor should prescribe an x-ray or pleural puncture.

If the pathology is detected even before the birth of the baby, then the gestational age, the presence of other anomalies and development are important here. By the way, it is important to understand that in the early stages of pregnancy, such a diagnosis may indicate the risk of chromosomal abnormalities. In such cases, the forecast further development and the child's life is regarded as unfavorable.

A favorable outcome with such pathology can be only if the accumulation of fluid is isolated and does not proceed against the background of non-immune fetal dropsy or polyhydramnios. If the parents have a desire to preserve the pregnancy and there are all rational prerequisites for this, a thorough examination of the fetus should be carried out in the complex. Such pregnancies are carried out under constant supervision, including ultrasound. There is a very real risk of hydrothorax growth, i.e. the volume of fluid may increase. In this case, in order to avoid the development of complications, invasive procedures are performed, during which excess fluid is eliminated and removed by means of a pleuroamniotic shunt. In fact, this is a routine puncture of the chest cavity of a baby inside the womb. All manipulations are carried out exclusively under ultrasound guidance.

Sincerely, Natalia.

Patients with diseases associated with the lungs are interested in what is hydrothorax. Transudate is a fluid that begins to accumulate in the body due to a malfunction of the circulatory or lymph circulation systems, in the process of its formation no inflammation occurs, while its accumulation in the respiratory organs (pleural region) is called pulmonary hydrothorax. Often this is a complication of existing diseases, and not a separate ailment (for example, with cancer, with pneumonia). In the case when the episode concerns a pregnant woman, such a problem can occur not only in the mother, but also in the fetus.

Hydrothorax, what is it?

It is worth starting with the fact that a syndrome such as pulmonary hydrothorax has not only individual symptoms, but also has three forms of manifestation, its classification is as follows:

• Left-sided hydrothorax;
• Right-sided hydrothorax;
• Bilateral hydrothorax.

The history of the development of this disease rarely recorded the defeat of only one lung (especially the left). Most often, it happens that one of the organs begins to suffer (on the left or on the right), and after that the disease will spread to the partner organ, acquiring a more familiar form of flow (bilateral).

All types have identical signs, methods of diagnosis and treatment.

As mentioned earlier, hydrothorax in the lungs can be caused by dysfunction of various systems, both lymph and blood accumulate in them. It is also customary to divide this into several groups:

• Hemothorax - an accumulation of blood;
• Chylothorax - accumulation of lymphatic fluid;

As with other diseases, organ dysfunction will not be noticeable in the early stages. In this situation, everything depends on the volume of fluid that has managed to accumulate in the lungs, up to the 200 ml border a person usually does not know about any syndrome. If you do not pay attention to this problem, the total volume of the liquid can exceed several liters, which is already very dangerous. If you ignore treatment, hydrothorax can cause many complications, including:

• Heart attack;
• Renal failure;
• Liver dysfunction;
• Respiratory swelling;
• Hypoxia (respiratory failure);
• Impaired blood circulation.

Usually, such an ailment does not pose a mortal danger, if you do not greatly delay the trip to the doctor, but this is an indicator of another, more serious illness.

Causes of pulmonary hydrothorax

What can cause hydrothorax in the lungs? Medicine has not fully investigated this phenomenon and does not know about all the possible roots of the problem. However, some of them are still discovered and proven, this list includes such diseases:

1. Renal failure that accompanies nephrotic syndrome. Hydrothorax of the lungs in this case is provoked by low oncotic pressure;
2. Myxedema - a lack of hormones thyroid gland... The metabolism of proteins, their absorption in the digestive tract is disturbed, and if you eat foods that do not contain it, then there will be complications, often leading to dystrophy;
3. Hydrothorax of the lungs in oncology is manifested not so much for physiological reasons, but rather for mechanical ones. The circulation of lymph and blood is disrupted, due to which the pressure rises;
4. Cirrhosis of the liver;
5. Ascites. Pathological accumulation of fluid in the abdominal cavity, which creates excessive pressure and, as a result, it can seep through the pores into the pleural space, as a result, hydrothorax is formed in the lungs;
6. In the same way, small hydrothorax can be provoked during peritoneal dialysis. This procedure involves injecting a large volume of fluid into the abdominal cavity and then removing it.
7. With chronic heart failure (CHF), doctors often find a syndrome of pulmonary hydrothorax (hemothorax) of varying severity. Blood congestion that can form in any part of the body increases the hydrostatic pressure and against this background the fluid passes into the pleural region, this situation in most cases is bilateral. The syndrome has the following symptoms:

• Tachycardia;
• Shortness of breath;
• Night toilet, with less volume;
• Attacks of aggression;
• Insomnia;
• Depression;
• General fatigue during the daytime.

In addition to all of the above, the causes of hydrothorax can be as follows:

• Various tumors, edema during pregnancy;
• Pneumonia;
• Ovarian fibroma;
• Physical injuries in the area chest;
• Anemia;
• Pericarditis;
• Amyloidosis.

Hydrothorax of the lungs, symptoms

It is worth immediately highlighting two categories of this ailment, which are very different from each other and have different signs.

• Small hydrothorax (up to 150 ml of accumulated fluid). It is a kind of complication of the underlying disease, and not an individual disease;
• Total hydrothorax. Such a problem can manifest itself without any precursor diseases;
• Encased;

If you do not take into account the symptoms that are characteristic of a particular disease, then this ailment has the following general signs:

• Complaints of chest pain;
• Fingers may swell;
• Dry cough;
• Swelling of different parts of the body;
• Tachycardia;
• The presence of sleep disorders;
• Shortness of breath;
• Enlarged lymph nodes;
• Muscle pain;
• Forced pose. It expresses the tilt of the body to the side where more fluid has accumulated;
• Restrained movements;
• In severe cases - chest deformity (it sticks out forward);

For the most part, these symptoms only develop over time as the problem begins to take on a more serious form. Having found them, you should consult a doctor, and if he diagnoses you with hydrothorax, treatment should be prescribed in a timely manner in order to avoid unpleasant consequences.

When answering the question: "Hydrothorax, what is it?" it is worth noting that, unlike the same pleurisy, during the course, this disease is not accompanied by inflammation.

Diagnostics

The examination, to determine hydrothorax what it is and what is its etiology, in each specific case includes a number of procedures:

• Fluoroscopy. The problem areas on the X-ray look like a uniform darkening;
• Lung percussion. In this case, the percussion sound will be dull, and above the upper boundary of the liquid, the tympanic sound will be dull (similar to the sound of a drum);
• Puncture of the pleural cavity with hydrothorax is mandatory. This is done in order to determine the nature of the fluid that has accumulated in the respiratory organs.

Important! X-rays will not be useful for mild disease, since the amount of blood or lymph is minimal (100-200 ml).

• Ultrasound. With it, you can determine even the smallest accumulation of fluid (from 10 ml), and also see at which point pleural puncture will be more successful. Often used in diagnosis during pregnancy;
• CT scan;

In addition, a number of laboratory tests are taken:

• Rivolt's test (distinguishes transudate from inflammatory fluid), in the case of hydrothorax, the test is negative;
• Blood test;
• General collection of urine;
• Cytology;
• Bacteriology;
• Study of material obtained by puncture.

Important! In gynecology, this complication also occurs - fetal hydrothorax during pregnancy. The difficulty lies in the fact that the mother may not have any symptoms and the disease as such. The syndrome can be caused by similar causes, as in an adult body, but they are much more difficult to detect, especially if the equipment for research is of the middle class, in which case an X-ray will definitely not help. Most often, the heart is the root of the disease. Also, there are situations when the work of the circulatory system is disrupted during the Rh-conflict. If the child is a newborn, then such a diagnosis can be made with an entwined umbilical cord or birth injuries.

Hydrothorax treatment

How is this painful condition treated? It is necessary to understand that treatment with folk remedies in this case can carry not only zero effect, but also a huge danger to human health. Help should be provided in a timely manner by a treating specialist.

And at the moment there are different ways to remove excess fluid from the human body, however, in the case of the lungs, such operations involve a puncture in the soft tissues:

• Pleurocentesis;
• Thoracocentesis;
• Drainage of the pleural cavity (Bulau drainage method);
• Puncture with aspiration.

In this way, it is only possible to temporarily alleviate hydrothorax, the treatment of which should primarily imply the therapy of the underlying disease. Why don't doctors perform these procedures for any accumulation of transudate? With each next "pumping" in the body, the concentration of protein decreases, and if it does not have time to recover, it is fraught with complications.

However, despite the characteristics of each disease, there are a number of recommendations that must be followed:

• Normalize the diet. He should exclude salty foods, coffee, alcohol, excessive amounts of liquids. A nutritionist can help balance your diet;
• Avoid stressful situations;
• For ailments with the heart, they are prescribed fractional meals (5-6 times a day). From medications, cardiac glucosides, phosphodiesterase inhibitors (enhancement of the contractile function of the myocardium) are used. In addition, diuretics are used to remove excess fluid;
• Kidney failure can only be cured together with the underlying disease. Bed rest and diet are also recommended;

For the prevention of hydrothorax, various folk recipes diuretics:

1. Pour in 0.5 tsp. chopped parsley 500 ml boiling water for 12 hours and drink 1 tbsp. l. before eating;
2. Birch juice. No more than 2 times a day, 100 ml;
3. Fresh from blackberries, black mountain ash or irgi, take 3 times a day, 1 tbsp. l .;
4. The following herbs are often used:

• Birch leaves;
• Lingonberry leaves;
• Horsetail;
• Bearberry;
• Orthosyphon.

There are many situations during which pulmonary hydrothorax can occur. For example, for oncological diseases this is quite common and brings additional problems and aggravation general condition sick. First aid should be provided by a doctor, if the root cause is cured, then such a complication will go away by itself and will not have time to develop into something more. After therapy, an X-ray examination is prescribed in order to make sure that the course of treatment was successful and all possible problems have been eliminated.

The dropsy of the fetus is called it pathological condition, in which fluid accumulates in all cavities of the body and generalized edema is present (edema of the whole body - anasarka).

In most cases, dropsy of the fetus is observed with Rh-conflict pregnancy and hemolytic disease of the newborn. The prevalence of this condition is 1 case per 1000-14000 births. Distinguish between immune and non-immune dropsy of the fetus.

Causes

The main reason for the development of immune dropsy of the fetus is its hemolytic disease.

The reason that led to the development of non-immune dropsy of the fetus often remains unrecognized, but the following factors are distinguished:

• chromosomal abnormalities of the fetus (Down syndrome, mosaicism, trisomies, Shereshevsky-Turner syndrome and others);
• gene diseases: lack of glucose-6-phosphate dehydrogenase, A-thalassemia, Noonan syndrome, achondrogenesis, thanatophoric dwarfism, Pena-Shocky syndrome, multiple pterygium syndrome, achondroplasia;
• malformations of the chest cavity (dysplasia of the chest, diaphragmatic hernia, cystic adenomatous lung disease);
• malformations of the urinary system (congenital nephrotic syndrome, malformations of the urethra and kidneys);
• cardiovascular pathology (cardiomyopathy, congenital heart defects, anatomical defects, arterial-venous shunts)
• chorioangioma of the placenta;
• with multiple pregnancies (fetal-fetal transfusion, acardial twins);
• infectious diseases of the mother during pregnancy ( cytomegalovirus infection, syphilis, parvovirus infection, toxoplasmosis, Coxsackie viral pancarditis);
• complications of pregnancy (preeclampsia, severe anemia, uncorrected diabetes, hypoproteinemia);
• congenital metabolic disorders (type 4 mucopolysaccharidosis, Gaucher's disease, neuraminidase deficiency, Morquio's disease);
• congenital tumors of the brain and spinal cord, urinary system and digestive tract, liver, sacrococcygeal teratoma, neuroblastoma.

Diagnostics

Diagnosis of fetal dropsy is aimed at establishing the cause that caused it. First of all, the blood group and Rh factor are determined to confirm / exclude the Rh conflict and immune dropsy of the fetus.

An analysis of the life history ( infectious diseases in the past, operations, chronic pathology), obstetric and gynecological history (presence gynecological pathologies, course and outcomes of previous pregnancies), the course of this pregnancy, its complications, total weight gain, etc. are analyzed.

The main diagnostic method is fetal ultrasound. Ultrasound signs include:

• swelling of the placenta ("thick placenta");
• excess amniotic fluid (polyhydramnios);
• fruit size over normal due to edema (in particular, the increased size of the abdomen due to ascites compared to the size of the head);
• accumulation of fluid in all cavities of the fetal organism (hydropericardium, ascites, hydrothorax)
• swelling of the subcutaneous fat layer in the form of a double circuit;
• swelling of the scalp, arms, and legs;
• cardiomegaly (enlargement of the heart);
• thickening of the intestines (swelling of the walls);
• enlarged liver and spleen (hepatosplenomegaly)
• "Buddha pose" - a swollen belly with limbs and spine removed from it;
• low physical activity in combination with other signs.

After ultrasound, amniocentesis or cordocentesis is prescribed to determine the karyotype of the fetus, obtain fetal blood (assessment of hemoglobin, protein) and possible intrauterine treatment. In order to exclude intrauterine infection, PCR is prescribed for suspected infections.

Treatment of fetal dropsy

If congenital malformations of the fetus are detected that are incompatible with life (1-2 trimester of pregnancy), the woman is offered an abortion. In the case of refusal to terminate, continue to monitor the course of pregnancy and the development of the disease until the time allows for prenatal (antenatal) therapy.

Treatment of fetal dropsy consists in carrying out cordocentesis and blood transfusion into the umbilical cord (in the case of severe anemia and a decrease in hematocrit to 30 and below). If necessary, replacement blood transfusion is repeated after 2-3 weeks.

If fetal-fetal twin transfusion is detected, laser coagulation vessels connecting the fruits. If it is not possible to carry out prenatal treatment, the risk of premature birth is assessed in relation to antenatal fetal death and delivery is carried out ahead of schedule with the preliminary appointment of drugs to accelerate the maturation of the fetal lungs. In some cases, the administration of cardiac glycosides to the mother is shown to normalize the cardiac activity of the fetus.

Before delivery (as a rule, it happens on a planned basis), they are preparing for the birth of a child with dropsy. The delivery room should be equipped with equipment for cardiopulmonary resuscitation, a resuscitation team of 2-3 resuscitators and 2-3 neonatologists is formed (after the birth of a child, they immediately intubate and artificially ventilate the lungs with 100% oxygen).

Immediately after birth and resuscitation, pericardiocentesis (removal of accumulated fluid by puncture of the pericardial sac), pleural puncture (removal of fluid from the pleural cavity) and laparocentesis (suction of fluid from the abdominal cavity) are performed. A catheter is placed in the umbilical artery for subsequent infusions of red blood cells or blood.

Forecasts

The prognosis for non-immune fetal dropsy is unfavorable and the percentage of surviving children is 20-33%. With the development of dropsy in the first trimester, pregnancy, as a rule, ends with a spontaneous abortion; in the second and third trimesters, the risk of antenatal fetal death is high.

With immune dropsy, the prognosis is more reassuring, the effect of prenatal and postnatal treatment reaches 80-90%.

Some studies during pregnancy