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Nagai A, Sugimoto K, Yamamoto T, Wakabayashi H, Kaneda S, Nakagawa N, Yamamoto N. A case of refractory hepatic hydrothorax due to pleuroperitoneal communication successfully controlled by diaphragmatic plication and subsequent peritoneovenous shunting. Clin J Gastroenterol 2024; 17:137-142. [PMID: 38032453 DOI: 10.1007/s12328-023-01889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
In general, control of hepatic hydrothorax is difficult, and patients have a poor prognosis. A case in which hepatic hydrothorax was well controlled for a long time after diaphragm plication and subsequent Denver shunt placement is reported. A 70-year-old man with decompensated liver cirrhosis presented with progressive exertional dyspnea. 5 years before admission, hepatic ascites associated with portal hypertension appeared, and a left pleural effusion subsequently developed. The pleural effusion was not controlled by salt restriction and diuretics. Based on the clinical findings, the existence of pleuroperitoneal communication was strongly suspected, and surgical diaphragmatic plication was performed. After the treatment, the pleural effusion did not accumulate, but ascites increased significantly, and conservative therapy was ineffective. For the treatment of massive ascites, a peritoneovenous shunt (Denver shunt®) was placed. Although more than 2 years have passed, the thoracoabdominal effusions have not accumulated, and the patient has been asymptomatic. The present case suggests that multidisciplinary treatment may improve the prognosis of patients with refractory thoracoabdominal effusions.
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Affiliation(s)
- Arisa Nagai
- Department of General Medicine, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kazushi Sugimoto
- Department of Clinical Laboratory, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takayuki Yamamoto
- Department of General Medicine, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hideki Wakabayashi
- Department of General Medicine, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shinji Kaneda
- Department of Thoracic Surgery and Cardiovascular Surgery, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Naoki Nakagawa
- Kuwana City Medical Center, 3-11 Kotobuki Town, Kuwana, Mie, 511-0061, Japan
| | - Norihiko Yamamoto
- Department of General Medicine, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
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Han SK, Baik SK, Kim MY. [Pulmonary Complications in Patients with Liver Cirrhosis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 82:213-223. [PMID: 37997217 DOI: 10.4166/kjg.2023.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Portal hypertension is a clinical syndrome defined by an increased portal venous pressure. The most frequent cause of portal hypertension is liver cirrhosis, and many of the complications of cirrhosis, such as ascites and gastroesophageal variceal bleeding, are related to portal hypertension. Portal hypertension is a pathological condition caused by the accumulation of blood flow in the portal system. This blood flow retention reduces the effective circulation volume. To compensate for these changes, neurotransmitter hormone changes and metabolic abnormalities occur, which cause complications in organs other than the liver. A hepatic hydrothorax is fluid accumulation in the pleural space resulting from increased portal pressure. Hepatopulmonary syndrome and portopulmonary hypertension are the pulmonary complications in cirrhosis by deforming the vascular structure. Symptoms, such as dyspnea and hypoxia, affect the survival and the quality of life of patients. These lung complications are usually underestimated in the management of cirrhosis. This review briefly introduces the type of lung complications of cirrhosis.
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Affiliation(s)
- Seul Ki Han
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
- Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
- Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
- Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Korea
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Granata A, Rahbari E, Pesce F, Gesualdo L, Zeiler M. Contrast-enhanced ultrasound in peritoneal dialysis: when and how to perform it. J Nephrol 2022; 35:1329-1337. [PMID: 35275378 DOI: 10.1007/s40620-022-01287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
In the field of peritoneal dialysis contrast enhanced ultrasound (CEUS) is a new add-on examination to B-mode ultrasound, but until recently it has never been systematically studied. Based on the experience of the Project Group "Integrated Imaging and Interventional Nephrology" of the Italian Society of Nephrology, CEUS is helpful for evaluating catheter malfunction, peritoneal-pleural communication, leakage, and herniation, and in particular it facilitates dynamic functional imaging of the catheter and its complications. The use of CEUS in peritoneal dialysis is simple, repeatable, safe, radiation-free, and appears to be less time-consuming and more cost-effective than other radiological imaging techniques such as peritoneography, computed tomography, magnetic resonance or peritoneal scintigraphy.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Via Messina 829, 95126, Catania, Italy
| | - Elnaz Rahbari
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Via Messina 829, 95126, Catania, Italy
| | - Francesco Pesce
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Matthias Zeiler
- Nephrology and Dialysis Unit, "C. e G. Mazzoni" Hospital, Via degli Iris 1, 63100, Ascoli Piceno, Italy.
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Wei ZMS, Rongqin ZMD. A Rare Case of Spontaneous Gastrobiliary Fistula Diagnosed by Oral Contrast-enhanced Ultrasound. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2019. [DOI: 10.37015/audt.2019.190822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the development of HH remains incompletely understood, the most acceptable explanation is that the pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm due to the raised abdominal pressure and the negative pressure within the pleural space. Patients with HH can be asymptomatic or present with pulmonary symptoms such as shortness of breath, cough, hypoxemia, or respiratory failure associated with large pleural effusions. The diagnosis is established clinically by finding a serous transudate after exclusion of cardiopulmonary disease and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces when necessary. Spontaneous bacterial empyema is serious complication of HH, which manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. The mainstay of therapy of HH is sodium restriction and administration of diuretics. When medical therapy fails, the only definitive treatment is liver transplantation. Therapeutic thoracentesis, indwelling tunneled pleural catheters, transjugular intrahepatic portosystemic shunt and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality is high in these extremely ill patients.
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Affiliation(s)
- Yong Lv
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
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Nuclear Imaging to Detect Diaphragmatic Perforation as a Rare Complication of Microwave Ablation. Case Rep Crit Care 2017; 2017:6541054. [PMID: 28392947 PMCID: PMC5368371 DOI: 10.1155/2017/6541054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/05/2017] [Indexed: 11/17/2022] Open
Abstract
Acquired diaphragmatic perforation leading to massive hepatic hydrothorax and respiratory failure is a rare complication of microwave ablation (MWA) of hepatocellular carcinoma (HCC). Imaging modalities to detect pleuroperitoneal communication remain poorly described. We report a nuclear imaging technique used to efficiently diagnose and locate diaphragmatic defects. A 57-year-old male with cirrhosis and HCC presented with respiratory distress after undergoing MWA of a HCC lesion. He was admitted to the intensive care unit for noninvasive positive pressure ventilator support. Chest radiography revealed a new large right pleural effusion. Large-volume thoracentesis was consistent with hepatic hydrothorax. The fluid reaccumulated within 24 hours; therefore an acquired diaphragmatic perforation induced by the ablation procedure was suspected. To investigate, 99mTechnetium-labeled albumin was injected into the peritoneal cavity. The tracer accumulated in the right hemi thorax almost immediately. The patient then underwent transjugular intrahepatic portosystemic shunting in efforts to relieve portal hypertension and decrease ascites volume. Unfortunately, the patient deteriorated and expired after few days. Although diaphragmatic defects develop in cirrhotic patients, such small fenestrations do not normally lead to rapid development of life-threatening pleural effusion. MWA procedures can cause large diaphragmatic defects. Immediate detection of this complication is essential for initiating early intervention.
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Hou F, Qi X, Guo X. Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis. Dig Dis Sci 2016; 61:3321-3334. [PMID: 27456504 DOI: 10.1007/s10620-016-4260-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of HH. AIM To evaluate the effectiveness and safety of pleurodesis for HH in a systematic review with meta-analysis. METHODS All relevant papers were searched on the EMBASE and PubMed databases. As for the data from the eligible case reports, the continuous data were expressed as the median (range) and the categorical data were expressed as the frequency (percentage). As for the data from the eligible case series, the rates of complete response and complications were pooled. The proportions with 95 % confidence intervals (CIs) were calculated by using random-effect model. RESULTS Twenty case reports including 26 patients and 13 case series including 180 patients were eligible. As for the case reports, the median age was 55 years (range 7-78) and 15 patients were male. The prevalence of ascites was 76 % (19/25). Seventeen (65.38 %) patients responded favorably to pleurodesis. As for the case series, the mean age was 51.5-63.0 years and 83 patients were male. The pooled prevalence of ascites was 90 % (95 % CI 81-97 %) in 7 studies including 71 patients. The complete response rate after pleurodesis was reported in all studies, and the pooled rate was 72 % (95 % CI 65-79 %). Complications related to pleurodesis were reported in 6 studies including 63 patients, and the pooled rate was 82 % (95 % CI 66-94 %). CONCLUSION Pleurodesis may be a promising treatment for HH, but carries a high rate of complications.
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Affiliation(s)
- Feifei Hou
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China.
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China.
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Müller T, Blank W, Leitlein J, Kubicka S, Heinzmann A. Endocavitary contrast-enhanced ultrasound: a technique whose time has come? JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:71-80. [PMID: 25349067 DOI: 10.1002/jcu.22250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/07/2014] [Indexed: 06/04/2023]
Abstract
Endocavitary use of contrast agents in sonography (US) is a relatively new method in diagnostic imaging, competing against gray-scale US, fluoroscopy, and endoscopy. This article describes established indications, demonstrates the techniques of evolving applications, and discusses their potential benefits. These benefits include the ability to obtain precise information about the placement of drains and the extent of fluid collections, and to accurately identify the location and features of strictures in various organs, and those of complications of fluid collections or abscesses, without resorting to ionizing radiation.
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Affiliation(s)
- Thomas Müller
- Klinikum am Steinenberg, Medizinische Klinik I, Reutlingen, Germany
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Sato S, Tobita H, Miyake T, Saitou T, Kinoshita Y. Bleeding in abdominal cavity revealed by contrast-enhanced ultrasonography. J Med Ultrason (2001) 2013; 40:289-91. [PMID: 27277252 DOI: 10.1007/s10396-013-0430-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 12/21/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Shuichi Sato
- Division of Gastrointestinal Endoscopy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan.
| | - Hiroshi Tobita
- Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tatsuya Miyake
- Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tsukasa Saitou
- Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, Izumo, Japan
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Kanso F, Nahon P, Blaison D, Trinchet JC, Beaugrand M, Seror O, Martinod E. Diaphragmatic necrosis after radiofrequency ablation of hepatocellular carcinoma: a successful surgical repair. Clin Res Hepatol Gastroenterol 2013; 37:e59-63. [PMID: 23137756 DOI: 10.1016/j.clinre.2012.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/10/2012] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
We report a case of complete hemidiaphragmatic necrosis with liver abscess complicating radiofrequency ablation of a large subdiaphragmatic hepatocellular carcinoma in a patient with unrecognized history of endoscopic oddi sphincterotomy. At 2-year follow-up after surgical repair using a pedicled latissimus dorsi flap, clinical examination and imaging did not show complication or cancer recurrence. The risk of complete hemidiaphragmatic necrosis resulting from both thermal and septic injuries should be considered when radiofrequency ablation is performed for liver dome tumors, particularly in patients with impaired oddi sphincter. In this septic situation, a latissimus dorsi flap appears as the unique opportunity to repair the injured hemidiaphragm.
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Affiliation(s)
- Frederic Kanso
- Université Paris 13, UPRES Sorbonne Paris Cité, 93206 Saint-Denis, France
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