Tension Hydrothorax

Abstract

We describe a case of tension hydrothorax in a patient with a massive left pleural effusion secondary to an empyema. Tension hydrothorax is uncommon, but important to recognize because, left untreated, this condition may lead to severe hemodynamic instability and death.

Point-of-care Ultrasound Identification of Tension Hydrothorax in the Emergency Department: A Case Series

“…The most common causes of pleural effusions are malignancy and infection. 2 Other potential causes are fluid overload states as seen in heart or liver failure; pulmonary embolism; congenital abnormalities; rheumatologic diseases; trauma; or iatrogenic causes. 2,4 Unusual causes include disseminated endometriosis, 5 gastric perforation, 4,6 and ventriculopleural shunt.…”

“…1 In adults the two most common causes of TH are infectious or malignant processes, although many causes have been identified. 2 The diagnosis is made based on clinical suspicion and can be supported with imaging via chest radiograph (CXR), point-of-care ultrasound (POCUS), or computed tomography (CT). These modalities may show hemithorax opacification or pleural effusion with contralateral mediastinal displacement.…”

Tension Hydrothorax from Disseminated Endometriosis

“…Tension hydrothorax is defined as a large pleural effusion that increases intrathoracic pressure enough to cause a shift in mediastinal structures and decrease venous return. 1 It differs from tension pneumothorax in that symptoms may develop slowly over time until a critical intrathoracic pressure is reached. As fluid accumulates in the pleural space, this causes the lung volume on the affected side to decrease, resulting in tachypnea, decreased breath sounds, and hypoxia.…”

“…In the adult population, malignancy and infection are the primary causes of tension hydrothorax. 1 Additional causes described in the literature include: ventriculopleural shunting; 2 , 3 peritoneal dialysis; 4 , 5 migration of ventriculoperitoneal shunts; 1 cirrhosis (hepatic hydrothorax); 6 ovarian hyperstimulation syndrome; 7 and central venous catheterization. 8 …”

Acute Tension Hydrothorax in a Cirrhotic Patient With Hepatic Hydrothorax Without Ascites

“…It is generally localized to the right side, in approximately 85% of cases, and rarely occurs in the absence of ascites [3,4]. This accumulation of excess fluid in the pleural space can lead to tension hydrothorax (TH), defined as a massive pleural effusion causing a contralateral shift of the mediastinum associated with hemodynamic abnormalities [5][6][7]. However, TH is an uncommon entity, and it is rarely found in cirrhotic patients without ascites [8,9].…”