Synonyms.—Thoracic Dropsy; Dropsy of the Chest; Dropsy of the Pleura.
Definition.—A collection of serous fluid within the pleural cavity without inflammation.
Etiology.—A secondary affection, being usually preceded by nephritis and cardiac lesions, causes of other forms of dropsy. It may also follow profound anemia due to chronic malaria, chronic enteritis, chronic dysentery, syphilis carcinoma, and occasionally it may be due to local causes.
Pathology.—Hydrothorax, unless due to cardiac affections, is usually bilateral. The quantity varies, and is generally greater on one side than the other. The retraction of the lung depends upon the quantity of fluid present, unless previous pleural adhesions have taken place. The fluid is free, not circumscribed. The pleural membrane is somewhat pale, and generally smooth. The fluid is of low specific gravity, 1.910 to 1.912, alkaline in character, clear, and of an amber color.
Symptoms.—The symptoms of the primary lesion may so obscure the condition of the pleura that it may be present for a long time without being suspected. As the fluid increases, however, dyspnea becomes a prominent symptom, and where the fluid has accumulated in large quantities may result in orthopnea, cyanosis, asthmatic seizures, cough, and profuse clammy sweating are also common, especially when due to heart lesions.
The physical signs are similar to those of pleurisy with effusion, though the friction sounds are absent.
Diagnosis.—The evidence of fluid in the pleural cavities without pain or fever, and an absence of friction sounds, coupled with a history of lesions of the kidneys, heart, or prolonged anemia, would suggest hydrothorax.
Prognosis.—This depends largely upon the primary lesion.
Treatment.—Since hydrothorax is but a part of general dropsy, our treatment will be directed along the lines for anasarca. We will think of apocynum, strophanthus, convallaria, cratsegus, cactus, and such remedies as increase absorption, the action of the kidneys, and add tone to the heart.
Where dyspnea becomes the chief difficulty, the physician will have to resort to aspiration.