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Gastroenterology13 papers

Hydrothorax

Last edited: 4/16/2026

Overview

Hydrothorax refers to the accumulation of serous fluid in the pleural cavity, which can be unilateral or bilateral. Bilateral hydrothorax, particularly when associated with central venous catheterization, requires prompt recognition and management to prevent severe cardiopulmonary compromise 1.

Diagnosis

  • Clinical signs include dyspnea, tachypnea, and decreased breath sounds on affected sides.
  • Diagnostic imaging (chest X-ray, CT thorax) confirms fluid accumulation and delineates extent.
  • Thoracentesis may be necessary for fluid analysis to rule out other causes like malignancy or infection 1.

    • Management

  • First-line: Bilateral chest tube insertion for significant bilateral hydrothorax 1.
  • Adjunctive: Monitoring central venous catheter position; repositioning or removal if suspected as the cause.
  • Supportive care: Oxygen therapy, mechanical ventilation if respiratory failure ensues.
  • Fluid management: Diuretics may be considered in cases with underlying heart failure contributing to fluid overload 1.

    • Special Populations

  • Pediatrics: Central venous catheter-related bilateral hydrothorax necessitates careful monitoring and bilateral drainage procedures 1.

    • Key Recommendations

  • Consider catheter-related complications in patients with acute cardiopulmonary deterioration, especially after central venous catheterization 1 (Evidence: Expert opinion).
  • Perform bilateral pleural drainage in cases of bilateral hydrothorax to ensure adequate decompression 1 (Evidence: Expert opinion).
  • Regularly reassess central venous catheter position in patients at risk for catheter-related hydrothorax to prevent complications 1 (Evidence: Expert opinion).

    • References

    1 Ross P, Seashore JH. Bilateral hydrothorax complicating central venous catheterization in a child: case report. Journal of pediatric surgery 1989. link80008-9)

    Original source

    1. [1]
      Bilateral hydrothorax complicating central venous catheterization in a child: case report. — Ross P, Seashore JH Journal of pediatric surgery (1989)
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