0
Editorials |

Cirrhotic Hydrothorax and the “Law of Unintended Consequences”

Carl M. Kirsch, MD, FCCP
Author and Funding Information

Affiliations: San Jose, CA 
 ,  Dr. Kirsch is Chief, Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose; and Clinical Professor of Medicine, Stanford University School of Medicine, Stanford, CA.

Correspondence to: Carl M. Kirsch, MD, FCCP, Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA 95128



Chest. 2000;118(1):2-4. doi:10.1378/chest.118.1.2
Text Size: A A A
Published online

Extract

Humans are evolutionary “works in progress,” who possess certain anatomic and physiologic features that may be considered disadvantages when compared with other animal species. The visceral and parietal pleural membranes along with the space that they surround have advantages and distinct disadvantages. The pleural surface seems to provide the optimal mechanism for smooth and frictionless movement of the lungs. The visceral and parietal pleural membranes and the minimal fluid lubricant between them allow the lung to expand and collapse uniformly and with minimal friction as it glides across the diaphragmatic and costal surfaces.1 Although sclerosis of the pleural space in humans can be shown to restrict diaphragmatic movement,2 the clinical consequences of this are thought to be small.3 Unfortunately, along with the theoretic advantages of a pleural space, come the “unintended consequences” of pneumothorax, hydrothorax, and hemothorax. Humans seem to be in the middle of the “pleural space spectrum,” with the elephant at one end and the horse (and possibly the buffalo) at the other end. The elephant has a pleural space that is partially or totally restricted by fibrous tissue connecting visceral to parietal pleura that may not allow clinically significant collections of liquid or air,45 although this has been challenged.6 The horse has fenestrations (termed incomplete mediastinum by veterinarians) connecting both pleural spaces that can produce bilateral pneumothorax or hydrothorax simultaneously.7 Humans rarely have an incomplete mediastinum, but may acquire fenestrations similar to those of the horse and buffalo after cardiac bypass surgery.8

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543