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Vidyani A, Sibarani CI, Widodo B, Purbayu H, Thamrin H, Miftahussurur M, Setiawan PB, Sugihartono T, Kholili U, Maimunah U. Diagnosis and Management of Hepatic Hydrothorax. Korean J Gastroenterol 2024; 83:45-53. [PMID: 38389460 DOI: 10.4166/kjg.2023.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 02/24/2024]
Abstract
Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).
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Affiliation(s)
- Amie Vidyani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Citra Indriani Sibarani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Budi Widodo
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Herry Purbayu
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Husin Thamrin
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
- Helicobacter pylori and Mycrobiota Study Group, Institute Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Poernomo Boedi Setiawan
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Titong Sugihartono
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Ulfa Kholili
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Ummi Maimunah
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
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Malick M, Shahid W, Lateef A, Zubair Z, Zaidi SM. Hepatic Hydrothorax Without Ascites: A Diagnostic And Management Challenge. J Ayub Med Coll Abbottabad 2023; 35(Suppl 1):S801-S803. [PMID: 38406913 DOI: 10.55519/jamc-s4-12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis who does not have other reasons to have a pleural effusion (e.g., cardiac, pulmonary, or pleural disease). Hepatic hydrothorax occurs in approximately 5-6% of patients with cirrhosis. It results from the ascitic fluid draining into the pleural cavity through the diaphragmatic defects. The presentation of patients with hepatic hydrothorax includes chest pain, hypoxemia, cough, shortness of breath and fatigue. The atypical feature, in this case, is the presence of hepatic hydrothorax in a patient with chronic liver disease without ascites. The management of hepatic hydrothorax is difficult. The initial treatment should be a low-salt diet plus diuretics. The best diuretic regimen is probably the combination of furosemide and spironolactone. However, about 25% of patients are refractory to this regimen, and additional therapy is indicated. This patient underwent thoracentesis, however, considering the re-accumulation of fluid, a pigtail catheter was placed which drained up to 8 liters of fluid.
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Affiliation(s)
- Maria Malick
- Department of Medicine, Patel Hospital, Karachi, Pakistan
| | - Wajeeha Shahid
- Department of Medicine, Patel Hospital, Karachi, Pakistan
| | - Anum Lateef
- Department of Medicine, Patel Hospital, Karachi, Pakistan
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Cadranel JFD, Ollivier-Hourmand I, Cadranel J, Thevenot T, Zougmore H, Nguyen-Khac E, Bureau C, Allaire M, Nousbaum JB, Loustaud-Ratti V, Causse X, Sogni P, Hanslik B, Bourliere M, Peron JM, Ganne-Carrie N, Dao T, Thabut D, Maitre B, Debzi N, Smadhi R, Sombie R, Kpossou R, Nouel O, Bissonnette J, Ruiz I, Medmoun M, Dastis SN, Deltenre P, Artru F, Raherison C, Elkrief L, Lemagoarou T. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations. BMC Gastroenterol 2023; 23:305. [PMID: 37697230 PMCID: PMC10496231 DOI: 10.1186/s12876-023-02931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. METHODS Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. RESULTS Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p < 0.001). A chest X-ray was performed before a puncture for 73% of the respondeurs (79% hepatogastroenterologists vs 54% pulmonologists; p < 0.001). In case of a spontaneous bacterial empyema, an albumin infusion was used by 73% hepatogastroenterologists and 20% pulmonologists (p < 0.001). A drain was used by 37% of the responders (37% hepatogastroenterologists vs 31% pulmonologists; p = 0.26).An Indwelling pleural catheter was used by 50% pulmonologists and 22% hepatogastroenterologists (p < 0.01). TIPS was recommended by 78% of the responders (85% hepatogastroenterologists vs 52% pulmonologists; p < 0.001) and a liver transplantation, by 76% of the responders (86% hepatogastroenterologists vs 44% pulmonologists; p < 0.001). CONCLUSIONS The results of this large study provide important data on practices of French speaking hepatogastroenterologists and pulmonologists; it appears that recommendations are warranted.
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Affiliation(s)
| | | | | | | | - Honoré Zougmore
- Hepatogastroenterology and Nutrition Department GHPSO Boulevard Laennec, 60100, Creil, France
| | | | | | - Manon Allaire
- Hepatogastroenterology Department, La Pitié Salpétrière, Paris, France
| | | | | | | | | | | | - Marc Bourliere
- Hepatogastroenterology department, Saint-Joseph, Marseille, France
| | | | | | - Thong Dao
- Hepatogastroenterology department, CHU Caen, Caen, France
| | - Dominique Thabut
- Hepatogastroenterology Department, La Pitié Salpétrière, Paris, France
| | | | - Nabil Debzi
- Hepatology Department CHU Mustapha, Alger, Algérie, Algeria
| | - Ryad Smadhi
- Hepatogastroenterology and Nutrition Department GHPSO Boulevard Laennec, 60100, Creil, France
- Hepatology Department CHU Mustapha, Alger, Algérie, Algeria
| | - Roger Sombie
- Gastroenterology Department, CHU Yalgado Ouedraogo Ouagadougou, Ouagadougou, Burkina Faso
| | - Raimi Kpossou
- Hepatogastroenterology Deparment, National Hospital and University Center Hubert Koutoukou Maga, Cotonou, Benin
| | - Olivier Nouel
- Hepatogastroenterology Department, St Brieuc, France
| | - Julien Bissonnette
- Department of Hepatology and Liver Transplantation, University of Montreal Hospital, Montreal, Canada
| | - Isaac Ruiz
- Department of Hepatology and Liver Transplantation, University of Montreal Hospital, Montreal, Canada
| | - Mourad Medmoun
- Hepatogastroenterology and Nutrition Department GHPSO Boulevard Laennec, 60100, Creil, France
| | | | | | - Florent Artru
- Hepatogastroenterology Department, Lausanne, Suisse, Switzerland
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Ghelfi J, Frandon J, Itkin M, Guiu B, Decaens T. Acute Central Lymphatic Obstruction Associated with Decompensated Cirrhotic Ascites and Hydrothorax. J Vasc Interv Radiol 2023; 34:1626-1629. [PMID: 37295556 DOI: 10.1016/j.jvir.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/28/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Affiliation(s)
- Julien Ghelfi
- University of Grenoble-Alpes, Saint Martin d'Hères, France; Department of Radiology, Grenoble-Alpes University Hospital, La Tronche, France; Institute for Advanced Biosciences - Institut national de la santé et de la recherche médicale (INSERM) U1209 - University of Grenoble-Alpes, La Tronche, France; University of Montpellier, Montpellier, France.
| | - Julien Frandon
- Department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Max Itkin
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Boris Guiu
- University of Montpellier, Montpellier, France; Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Thomas Decaens
- University of Grenoble-Alpes, Saint Martin d'Hères, France; Institute for Advanced Biosciences - Institut national de la santé et de la recherche médicale (INSERM) U1209 - University of Grenoble-Alpes, La Tronche, France; Department of Hepatology and Gastrointestinal Medical Oncology, Grenoble-Alpes University Hospital, La Tronche, France
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Romero S, Lim AKH, Singh G, Kodikara C, Shingaki-Wells R, Chen L, Hui S, Robertson M. Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax. World J Gastroenterol 2022; 28:5175-5187. [PMID: 36188717 PMCID: PMC9516676 DOI: 10.3748/wjg.v28.i35.5175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic hydrothorax (HH) is an uncommon and difficult-to-manage complication of cirrhosis with limited treatment options.
AIM To define the clinical outcomes of patients presenting with HH managed with current standards-of-care and to identify factors associated with mortality.
METHODS Cirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 were retrospectively identified. HH was defined as pleural effusion in the absence of cardiopulmonary disease. The primary outcomes were overall and transplant-free survival at 12-mo after the index admission. Cox proportional hazards analysis was used to determine factors associated with the primary outcomes.
RESULTS Overall, 84 patients were included (mean age, 58 years) with a mean model for end-stage liver disease score of 29. Management with diuretics alone achieved long-term resolution of HH in only 12% patients. At least one thoracocentesis was performed in 73.8% patients, transjugular intrahepatic portosystemic shunt insertion in 11.9% patients and 33% patients received liver transplantation within 12-mo of index admission. Overall patient survival and transplant-free survival at 12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidney injury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increased risk of mortality.
CONCLUSION Cirrhotic patients with HH are a challenging population with a poor 12-mo survival despite current treatments. Current smoking and episodes of AKI are potential modifiable factors affecting survival. HH is often refractory of diuretic therapy and transplant assessment should be considered in all cases.
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Affiliation(s)
- Sarah Romero
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Andy KH Lim
- Department of General Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
| | - Gurpreet Singh
- Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Chamani Kodikara
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | | | - Lynna Chen
- Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Samuel Hui
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Marcus Robertson
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
- Department of General Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
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Avula A, Acharya S, Anwar S, Narula N, Chalhoub M, Maroun R, Thapa S, Friedman Y. Indwelling Pleural Catheter (IPC) for the Management of Hepatic Hydrothorax: The Known and the Unknown. J Bronchology Interv Pulmonol 2022; 29:179-185. [PMID: 34753862 DOI: 10.1097/lbr.0000000000000823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatic hydrothorax (HH) is described as pleural effusion secondary to liver cirrhosis after ruling out other etiologies. We aim to assess the efficacy of an indwelling pleural catheter (IPC) placement in refractory HH in this systematic review and meta-analysis. METHODS A comprehensive search of literature was performed from inception to December 2020. The authors reviewed, selected, and abstracted the data from eligible studies into Covidence, a systematic review software. Cochrane criteria was used to rate each study for the risk of bias. The data abstracted were described using a random-effects model. Heterogeneity was evaluated using the I2 test. RESULTS Ten studies involving a total of 269 patients were included. The studies were analyzed for the proportion of pleurodesis achieved, the average time to pleurodesis, total complication rate, pleural infection rate, and mortality. A proportion of 47% of the total subjects included achieved spontaneous pleurodesis in an average duration of 104.3 days. The frequency of total complication rate was noted to be 30.36%. The incidence of pleural cavity infection was described to be 12.4% and death resulting from complications of IPC was 3.35%. CONCLUSION The current management options for the refractory pleural effusion in HH include repeated thoracenteses, transjugular intrahepatic portosystemic shunt, surgical repair of defects in the diaphragm, and liver transplantation. However, the cost, eligibility, and availability can be some of the major concerns with these treatment modalities. With this meta-analysis, we conclude that IPCs can provide an alternative therapeutic option for spontaneous pleurodesis.
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Affiliation(s)
- Akshay Avula
- Staten Island University Hospital, Northwell Health, New York, NY
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Gilbert CR, Shojaee S, Maldonado F, Yarmus LB, Bedawi E, Feller-Kopman D, Rahman NM, Akulian JA, Gorden JA. Pleural Interventions in the Management of Hepatic Hydrothorax. Chest 2021; 161:276-283. [PMID: 34390708 DOI: 10.1016/j.chest.2021.08.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatic hydrothorax can be present in 5% to 15% of patients with underlying cirrhosis and portal hypertension, often reflecting advanced liver disease. Its impact can be variable, because patients may have small pleural effusions and minimal pulmonary symptoms or massive pleural effusions and respiratory failure. Management of hepatic hydrothorax can be difficult because these patients often have a number of comorbidities and potential for complications. Minimal high-quality data are available for guidance specifically related to hepatic hydrothorax, potentially resulting in pulmonary or critical care physician struggling for best management options. We therefore provide a Case-based presentation with management options based on currently available data and opinion. We discuss the role of pleural interventions, including thoracentesis, tube thoracostomy, indwelling tunneled pleural catheter, pleurodesis, and surgical interventions. In general, we recommend that management be conducted within a multidisciplinary team including pulmonology, hepatology, and transplant surgery. Patients with refractory hepatic hydrothorax that are not transplant candidates should be managed with palliative intent; we suggest indwelling tunneled pleural catheter placement unless otherwise contraindicated. For patients with unclear or incomplete hepatology treatment plans or those unable to undergo more definitive procedures, we recommend serial thoracentesis. In patients who are transplant candidates, we often consider serial thoracentesis as a standard treatment, while also evaluating the role indwelling tunneled pleural catheter placement may play within the course of disease and transplant evaluation.
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Affiliation(s)
- Christopher R Gilbert
- Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
| | - Samira Shojaee
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD
| | - Eihab Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jason A Akulian
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jed A Gorden
- Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
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Yoon JH, Kim HJ, Jun CH, Cho SB, Jung Y, Choi SK. Various Treatment Modalities in Hepatic Hydrothorax: What Is Safe and Effective? Yonsei Med J 2019; 60:944-951. [PMID: 31538429 PMCID: PMC6753336 DOI: 10.3349/ymj.2019.60.10.944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Hepatic hydrothorax is a complication of decompensated liver cirrhosis that is difficult and complex to manage. Data concerning the optimal treatment method, other than liver transplantation, are limited. This study aimed to compare the clinical features and outcomes of patients treated with various modalities, while focusing on surgical management and pigtail drainage. MATERIALS AND METHODS Forty-one patients diagnosed with refractory hepatic hydrothorax between January 2013 and December 2017 were enrolled. RESULTS The mean Child-Turcotte-Pugh and model for end stage liver disease scores of the enrolled patients were 10.1 and 19.7, respectively. The patients underwent four modalities: serial thoracentesis (n=11, 26.8%), pigtail drainage (n=16, 39.0%), surgery (n=10, 24.4%), and liver transplantation (n=4, 9.8%); 12-month mortality rate/median survival duration was 18.2%/868 days, 87.5%/79 days, 70%/179 days, and 0%/601.5 days, respectively. Regarding the management of refractory hepatic hydrothorax, surgery group required less frequent needle puncture (23.5 times in pigtail group vs. 9.3 times in surgery group), had a lower occurrence of hepatorenal syndrome (50% vs. 30%), and had a non-inferior cumulative overall survival (402.1 days vs. 221.7 days) compared to pigtail group. On multivariate analysis for poor survival, body mass index <19 kg/m², refractory hepatic hydrothorax not managed with liver transplantation, Child-Turcotte-Pugh score >10, and history of severe encephalopathy (grade >2) were associated with poor survival. CONCLUSION Serial thoracentesis may be recommended for management of hepatic hydrothorax and surgical management can be a useful option in patients with refractory hepatic hydrothorax, alternative to pigtail drainage.
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Affiliation(s)
- Jae Hyun Yoon
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Joon Kim
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Chung Hwan Jun
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Bum Cho
- Department of Gastroenterology and Hepatology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Yochun Jung
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Sung Kyu Choi
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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Ortega Quiroz RJ, Moscote Granadillo M, Díaz Hernández A, Spath Spath A, Rodríguez María R, Reyes Romero A, Cure Cuse A, Estrada Redondo C, Cucunuba Toloza A. [Hepatic hydrothorax: presentation of 3 cases with different therapeutic approaches]. Rev Gastroenterol Peru 2019; 39:64-69. [PMID: 31042238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.
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Affiliation(s)
- Rolando J Ortega Quiroz
- División de Hepatología y Fibroscan, Clínica General del Norte. Barranquilla, Colombia. Universidad Libre. Barranquilla, Colombia
| | - Mario Moscote Granadillo
- Universidad Libre. Barranquilla, Colombia; División de Gastroenterología, Clínica General del Norte. Barranquilla, Colombia
| | | | - Alfonso Spath Spath
- Radiología Intervencionista, Centro de Diagnóstico Ultrasonográfico - CEDIUL. Barranquilla, Colombia
| | - Roberto Rodríguez María
- División de Hepatología y Fibroscan, Clínica General del Norte. Barranquilla, Colombia. Universidad Libre. Barranquilla, Colombia
| | | | - Anuar Cure Cuse
- División de Gastroenterología, Clínica General del Norte. Barranquilla, Colombia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Severe chronic liver disease (CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome (HPS), portopulmonary hypertension (PPH) and hepatic hydrothorax (HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.
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Jain S, Jain D, Singh AK, Jain VK. An Unusual Presentation in Urinothorax. Indian J Chest Dis Allied Sci 2016; 58:195-197. [PMID: 30152656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Urinothorax is defined as the presence of urine in the pleural cavity. Leakage from the urinary tract can cause urinoma with retroperitoneal urine collection, and secondarily, urinothorax. We report the case of a 35-year-old female who presented with dyspnoea and right-sided chest pain. Chest radiograph revealed a right-sided pleural effusion. The patient had undergone left-sided ovarian cystectomy three months ago, had sustained a left-sided ureteric injury that required ureteric stent placement. Urinothorax was suspected as a consequence of ureteric injury; pleural fluid to serum creatinine ratio was found to be greater than one, confirming the diagnosis.
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Yamamoto M, Miyashita M, Okamoto S, Kitazono M, Murata K, Wada A, Takamori M. [Case Report; A case of the hepatogenic hydrothorax that art of pleurodesis succeeded by CPAP combination]. ACTA ACUST UNITED AC 2016; 104:590-2. [PMID: 26571748 DOI: 10.2169/naika.104.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Hepatic hydrothorax is an important and difficult-to-manage complication of cirrhosis and portal hypertension. Here, we aimed to study its clinical features and natural history. Complete clinical data, including outcomes, were abstracted from hospital records of patients with cirrhosis and ascites admitted to University of Texas Southwestern University teaching hospitals from January 2001 to July 2012. Hepatic hydrothorax was diagnosed based on currently accepted clinical characteristics of the disease, including a known diagnosis of cirrhosis, the presence of portal hypertension, pleural fluid analysis, and the absence of primary cardiopulmonary disease.Seventy-seven of 495 (16%) hospitalized cirrhotic patients with pleural effusion (28 female; mean age, 52 yr) met the criteria for diagnosis of hepatic hydrothorax. Resting dyspnea and cough were the most prominent presenting symptoms, occurring in 34% and 22% of patients, respectively. Pleural effusions were most often right-sided (56/77; 73%), followed by left-sided only (13/77; 17%) and bilateral effusions (8/77; 10%); 7 (9%) patients did not have detectable ascites. The mean Model for End-Stage Liver Disease (MELD) score at presentation was 16. The serum to pleural fluid albumin gradient (SPAG) was ≥1.1 in all 48 patients in whom it was measured. Most patients (64/77; 83%) were managed with diuretics and/or thoracentesis, while 8 (10%) underwent transjugular intrahepatic portosystemic shunt (TIPS) and 5 (7%) underwent liver transplant. A total of 44 of 77 (57%) patients died during a mean follow-up of 12 months. The average time from presentation to death for all patients was 368 days, while for those after TIPS it was 845 days. No deaths were reported in the liver transplant group. The data indicate that a substantial number of patients with hepatic hydrothorax had what may be considered atypical presentations, including left-sided only effusions, or pleural effusion without ascites. Here, we propose that the term "serum to pleural fluid albumin gradient (SPAG)" be used to describe the gradient between serum and pleural fluid albumin levels and suggest that not only is it consistent with the portal hypertensive pathophysiology of hepatic hydrothorax, but also it is a useful criterion for diagnosis of hepatic hydrothorax. Finally, the overall outcome of hepatic hydrothorax was extremely poor, except in those undergoing TIPS or liver transplantation.
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Affiliation(s)
- Ricardo Badillo
- From the Department of Medicine (RB), University of Texas Southwestern, and Parkland Memorial Hospital (RB), Dallas, Texas; and Department of Medicine (DCR), Medical University of South Carolina, Charleston, South Carolina
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Endo K, Iida T, Yagi S, Yoshizawa A, Fujimoto Y, Ogawa K, Ogura Y, Mori A, Kaido T, Uemoto S. Impact of preoperative uncontrollable hepatic hydrothorax and massive ascites in adult liver transplantation. Surg Today 2014; 44:2293-9. [PMID: 24509883 DOI: 10.1007/s00595-014-0839-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 12/16/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. METHODS We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. RESULTS Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7%, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9%; 3 years: 58.9 vs. 77.7%; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis. CONCLUSIONS Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.
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Affiliation(s)
- Kosuke Endo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan,
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Bhageria A, Nayak B, Seth A, Dogra PN, Kumar R. Paediatric percutaneous nephrolithotomy: single-centre 10-year experience. J Pediatr Urol 2013; 9:472-5. [PMID: 23498666 DOI: 10.1016/j.jpurol.2013.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/04/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is a standard management option for complex and large renal calculi. In children, there is some concern over potential perioperative complications. We reviewed our 10 years of experience of PCNL in children and present our data. MATERIAL AND METHODS Data for paediatric patients who underwent PCNL at our centre in the last decade were retrieved. PCNL was performed in standard prone position under fluoroscopic guidance. Patient characteristics, outcomes and complications were reviewed. Complications were graded according to the modified Clavien system. A comparison was also made between supracostal and infracostal accesses. RESULTS 95 children underwent PCNL in our institute in the last decade. 7 patients had bilateral PCNL. The most common presentation was flank pain (85%). 83% patients were stone-free after first PCNL and overall 94% were stone free after second-look PCNL and auxillary procedures. 6 cases had clinically insignificant residual fragments. Supracostal puncture was performed in 32 cases. Complications were higher in the supracostal puncture group (16 (50%)) and included fever in 11, sepsis in 2 and hydrothorax in 3 patients. There were 7 (10%) complications in the infracostal group: fever in 5 and perinephric collection in 2 patients. 16 patients had grade 1, 9 had grade 2 and another 2 cases developed grade 3 complications. CONCLUSION PCNL is a safe and effective procedure in children. It enables excellent stone clearance with minimal number of interventions.
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Affiliation(s)
- Anand Bhageria
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Sıra MM, Sıra AM, Behairy BES, Bakır RM, El-Hagaly MA. Hepatic hydrothorax in the absence of ascites in a child with autoimmune hepatitis: Successful management with octreotide and pleurodesis. Turk J Gastroenterol 2013; 24:174-83. [PMID: 23934468 DOI: pmid/23934468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatic hydrothorax is a rare complication of liver cirrhosis and portal hypertension. It carries a diagnostic and therapeutic difficulty especially if occurring in the absence of ascites. We report a nine-year-old child with autoimmune hepatitis type 1, who presented with a right-sided hepatic hydrothorax in the absence of ascites. The patient was treated successfully with diuretics, octreotide and pleurodesis together with immunosuppressive therapy for autoimmune hepatitis. There was no recurrence of effusion after a long follow-up duration. In conclusion, hepatic hydrothorax should be considered in the differential diagnosis of pleural effusion occurring in children with cirrhotic liver, whether associated with ascites or not. Octreotide as a splanchnic vasoconstrictor can be used in establishing the diagnosis and in the treatment of hepatic hydrothorax. The need for liver transplantation in such patients may be avoided when the liver disease can be treated specifically.
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Affiliation(s)
- Mostafa Mohamed Sıra
- Department of Pediatric Hepatology, National Liver Institute, Menofiya University, 32511 Shebin El-koom, Menofiya, Egypt.
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Ramesh BY, Kumar N. Isolated bilateral severe fetal hydrothorax: complete resolution following a single postnatal thoracocentesis. Indian J Pediatr 2012; 79:392-4. [PMID: 21706243 DOI: 10.1007/s12098-011-0502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 06/10/2011] [Indexed: 02/05/2023]
Abstract
Isolated pleural effusion is a rare condition in a fetus or neonate with high mortality. When there are no other findings of hydrops fetalis or documented etiology such as inflammatory, iatrogenic or cardiac problems exist, isolated pleural effusion is considered. Timely diagnosis and management not only avoids mortality but also results in excellent prognosis. For fetal hydrothorax, intrauterine management is usually recommended. For those who present late, postnatal management includes intubation, thoracocentesis, ventilation and supportive care. The authors present isolated bilateral severe hydrothorax in a preterm neonate that resulted in severe respiratory compromise at birth. A single postnatal thoracocentesis resulted in complete resolution. No definite etiology for hydrothorax could be established. He had normal growth and development during his follow up till 1 year of age.
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Affiliation(s)
- Bhat Y Ramesh
- Department of Pediatrics, Kasturba Medical College, Manipal University, Udupi District, Manipal, 576104 Karnataka, India.
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Li XJ, Jia YJ, Chen L. [Clinical observation of thermotherapy combined with thoracic injection of lentinan in treatment of cancerous hydrothorax of patients with lung cancer]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2011; 31:1062-1065. [PMID: 21910335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To study the therapeutic effect and mechanism of thermotherapy combined with thoracic injection of lentinan in treatment of cancerous hydrothorax (CH) in patients with lung cancer. METHODS Sixty lung cancer patients complicated with CH were randomly assigned to the observation group and the control group, 30 in each. CH was released by closed drainage of the thoracic cavity in all patients. Thermotherapy was given to patients in the observation group after lentinan was thoracically injected, while lentinan was thoracically injected to patients in the control group. RESULTS The total effective rate of CH improvement was 73.3% (22/30) in the control group and 83.3% (25/30) in the observation group, showing insignificant difference (P>0.05). The stability rate and the weight stability rate by Karnofsky's performance scoring in the observation group were superior to those of the control group, showing significant difference (P<0.05). No hematological reaction, hepatic or renal damage occurred before and after treatment in both groups. Fever, thoracalgia, dyspnea, rash, nausea and vomit appeared in few patients of the two groups, showing insignificant difference (P>0.05). CD3+, CD4+, CD4+/CD8+, and NK obviously increased and CD8+ decreased in the observation group after treatment, showing significant difference from those before treatment (P<0.05). Compared with the control group after treatment, CD3+, CD4+, CD4+/CD8+, and NK obviously increased, CD8+ increased in the observation group (P<0.05). CONCLUSION Thermotherapy combined with thoracic injection of lentinan showed better effect in treatment of CH in patients with lung cancer. No obvious adverse reaction was seen.
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Affiliation(s)
- Xiao-jiang Li
- Department of Oncology, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193
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Díaz Mancebo R, Del Peso Gilsanz G, Rodríguez M, Fernández B, Ossorio González M, Bajo Rubio MA, Selgas Gutiérrez R. [Pleuroperitoneal communication in patients on peritoneal dialysis. One hospital's experience and a review of the literature]. Nefrologia 2011; 31:213-217. [PMID: 21461016 DOI: 10.3265/nefrologia.pre2011.jan.10762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2011] [Indexed: 05/30/2023] Open
Abstract
Peritoneal dialysis is a treatment alternative in patients with advanced chronic kidney disease. The infusion of liquid into the peritoneal cavity leads to an increase in intra-abdominal pressure, which can sometimes produce leaks to the chest, giving rise to pleuroperitoneal communication. This is not a common complication, but it brings about high drop-out rates among patients using the technique. Diagnosis is easy and must be suspected in patients with sudden dyspnoea with low ultrafiltration and pleural effusion in the chest x-ray. Peritoneal rest and a temporary transfer to haemodialysis, and pleurodesis can be effective treatment strategies.
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Affiliation(s)
- R Díaz Mancebo
- Servicio de Nefrología, Hospital Universitario La Paz, Paseo de la Castellana, Madrid.
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Li HC, Li X, Tang CW. [Progress in the diagnosis and treatment of hepatic hydrothorax]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:958-960. [PMID: 20038347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Hong-cui Li
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, China
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Ye YF, Zhang HC, Xie YN, Sun JJ, Wang YN. A case of neurofibromatosis type I presenting with rapid enophthalmos caused by thoracoentesis. Clin Exp Ophthalmol 2009; 37:752-4. [PMID: 19788680 DOI: 10.1111/j.1442-9071.2009.02115.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Witlox RSGM, Lopriore E, Walther FJ, Rikkers-Mutsaerts ERVM, Klumper FJCM, Oepkes D. Single-needle laser treatment with drainage of hydrothorax in fetal bronchopulmonary sequestration with hydrops. Ultrasound Obstet Gynecol 2009; 34:355-357. [PMID: 19681165 DOI: 10.1002/uog.7316] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Bronchopulmonary sequestration (BPS) is sometimes associated with hydrothorax and hydrops in utero. In the absence of fetal hydrops, perinatal outcome is favorable and justifies expectant management. In the presence of fetal hydrops, perinatal outcome is reported to be extremely poor and intervention should be considered. Therapeutic options include open fetal surgery, minimally invasive coagulation of the blood supply and thoracoamniotic shunting. We present the first case of fetal hydrops and a large hydrothorax due to BPS treated successfully with one ultrasound-guided thin needle insertion, through which both laser coagulation of the feeding artery and drainage of the hydrothorax were performed. Following the procedure the hydrothorax and hydrops gradually disappeared and the BPS diminished in size. A healthy neonate was delivered uneventfully at term. We describe the case and discuss the different therapeutic options.
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Affiliation(s)
- R S G M Witlox
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Centre, PO Box 9600, Leiden 2300 RC, The Netherlands.
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Siddappa PK, Kar P. Hepatic hydrothorax. Trop Gastroenterol 2009; 30:135-141. [PMID: 20306741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hepatic hydrothorax is defined as significant pleural effusion (usually greater than 500 mL) in a cirrhotic patient, in the absence of underlying pulmonary or cardiac disease. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with unilateral pleural effusion, most commonly right-sided. Hydrothorax is uncommon, and is found in 4-6% of all patients with cirrhosis and up to 10% in patients with decompensated cirrhosis. Although ascites is usually present, hydrothorax can occur in the absence of ascites. Patients with hepatic hydrothorax usually have advanced liver disease with portal hypertension and most of them require liver transplantation. Current insight into the pathogenesis of this entity has led to improved treatment modalities such as portosystemic shunts (TIPS) and video-assisted thoracoscopy for closure of diaphragmatic defects. These modalities may provide a bridge towards transplantation.
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Deurloo KL, Devlieger R, Lopriore E, Klumper FJ, Oepkes D. Isolated fetal hydrothorax with hydrops: a systematic review of prenatal treatment options. Prenat Diagn 2008; 27:893-9. [PMID: 17605152 DOI: 10.1002/pd.1808] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of prenatal therapeutic interventions on perinatal outcome in pregnancies complicated by isolated fetal hydrothorax with hydrops. METHODS A systematic review of the literature from January 1982 to January 2006 of perinatal outcome in pregnancies with isolated fetal hydrothorax with hydrops with any form of prenatal treatment was conducted. RESULTS Forty-four articles met our selection criteria, reporting a total of 172 fetuses treated prenatally. Reported treatment options were single (n = 13) or serial thoracocentesis (n = 18), thoraco-amniotic shunt placement (n = 100) or a combination of thoracocentesis and shunting (n = 36). Four case-reports described pleurodesis with OK-432, (n = 3) and intrapleural injection of autologous blood (n = 2). Overall survival rate was 63%, ranging from 54% for single thoracocentesis to 80% in the 5 cases treated with pleurodesis, without statistically significant differences between the treatment modalities. Shunt-placement with or without prior thoracocentesis was most often described, with survival rates of 67 and 61% respectively. DISCUSSION The available literature consists exclusively of case reports and case series. This systematic review suggests that with prenatal intervention, perinatal survival rates around 63% are possible. There is a need for prospective, adequately controlled studies with long-term follow-up to determine the best treatment and more reliable outcome data in pregnancies complicated by fetal hydrothorax with hydrops.
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Affiliation(s)
- K L Deurloo
- Fetal Medicine Unit, Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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Abstract
PURPOSE OF REVIEW This review highlights the pathophysiological mechanisms, incidence, clinical features, as well as the diagnosis and treatment of pleural effusions in the neonate. RECENT FINDINGS Pleural effusions are rare except in hydropic neonates. Elevated pleural fluid/serum immunoglobulin G ratio may be a diagnostic marker for congenital chylothorax in utero. Chylothorax may be congenital or acquired. Hydrothoraces may appear at any time during the neonatal period and are related to infectious and noninfectious aetiologies. Haemothorax is defined as the presence of blood in the pleural space. Parenteral nutrition leakage may occur in a newborn with a venous central catheter leading to an effusion that looks like a chylothorax. The value of elevated pleural fluid N-terminal pro-brain natriuretic peptide levels as a marker of congestive heart failure is not yet established in neonates. More recently, in cases of chylothorax that did not resolve with drainage and bowel rest, the use of somatostatin or its analogue octreotide has been described with success. If conservative management fails after 5 weeks, surgical intervention is indicated. SUMMARY Clinicians must be aware of the wide range of disorders causing pleural effusions, the different types and clinical presentations, differential diagnosis, and how to treat each specific case.
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Affiliation(s)
- Gustavo Rocha
- Division of Neonatology, Department of Paediatrics, São João Hospital, Porto, Portugal.
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Abstract
Hepatic hydrothorax is defined as a significant pleural effusion (usually greater than 500 ml) in a cirrhotic patient, without an underlying pulmonary or cardiac disease. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with a unilateral pleural effusion, most commonly right-sided. In the vast majority of cases, patients with hepatic hydrothorax have end-stage liver disease. Therefore, they should be considered potential candidates for orthotopic liver transplantation. Until the performance of transplantation, other therapeutic modalities should be applied in order to relieve symptoms and prevent pulmonary complications.
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Abstract
A patient sustained high-voltage electrical burns with third-degree burns over 35.5% of his body surface, which included a large direct wound on the left chest wall, exposing the heart. The heart and lungs were severely injured. Subsequently, hydrothorax, hydropericardium, and respiratory failure developed. He was successfully treated with fluid resuscitation, antibiotics, drainage of the pericardium and pleural cavities, early removal of necrotic tissue, skin grafting, and reconstruction of the chest wall with a 13 x 27-cm delay-flap, as well as a number of supportive measures. The patient gradually recovered and was discharged in 6 months.
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Affiliation(s)
- Ye-Yang Li
- Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University Medical College, Guangzhou People's Republic of China
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Mannheimer B, Wramsby M. [Right-sided hydrothorax--the only sign of ovarian hyperstimulation syndrome]. Lakartidningen 2007; 104:132-3. [PMID: 17302118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
The natural course of patients with cirrhosis is frequently complicated by the accumulation of fluid in the peritoneal or pleural cavities and interstitial tissue. Functional renal abnormalities that occur as a consequence of decreased effective arterial blood volume are responsible for fluid accumulation in the form of ascites and hepatic hydrothorax. Ascites is the most common complication of cirrhosis and poses an increased risk for infections, renal failure and mortality. Patients have a poor prognosis and it is estimated that nearly half will die in approximately 2 years without liver transplantation. Hepatic hydrothorax is defined as a pleural effusion greater than 500 mL (mostly right-sided) in patients with cirrhosis without cardiopulmonary disease; the estimated prevalence is approximately 5-10%. Liver transplantation is the most definitive cure for both conditions in those patients that are suitable candidates. However, the mainstay of therapy for minimizing fluid accumulation in both conditions includes sodium restriction and administration of diuretics. This article reviews the most current concepts of pathogenesis, clinical findings, diagnosis, and treatment of these complications of cirrhosis.
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Affiliation(s)
- Andrés Cárdenas
- Institut de Malalties Digestives i Metaboliques, University of Barcelona, Hospital Clinic, Villaroel 170, Barcelona 08036, Spain.
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Wynne R, Botti M, Copley D, Bailey M. The normative distribution of chest tube drainage volume after coronary artery bypass grafting. Heart Lung 2007; 36:35-42. [PMID: 17234475 DOI: 10.1016/j.hrtlng.2006.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 05/08/2006] [Accepted: 05/30/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little evidence exists to describe expected volumes of chest tube (CT) drainage after coronary artery bypass grafting (CABG). OBJECTIVES The study objective was to map the trajectory of CT drainage volumes from insertion to removal after CABG. DESIGN This was a retrospective, descriptive study. PATIENTS The study included 239 patients who underwent CABG at a single metropolitan hospital in Melbourne, Australia. RESULTS The sample (N = 234), aged 68.7 years (standard deviation [SD] 9.9), was predominantly male (N = 185, 79.1%). The mean duration of CT insertion was 45.2 hours (SD 26.7), and total drainage volume was 1300.6 mL (SD 763.8). Drainage volumes plateau to 31 mL per hour, 8 hours after surgery. From 24 to 48 hours, the mean drainage was 21 mL per hour. Drainage volumes varied between genders. CONCLUSIONS Evidence of similar drainage patterns in other populations is difficult to locate. If the pattern of drainage shown in this study is consistent, experimental intervention studies comparing standard removal time and earlier removal are recommended. If not, prospective collection of relevant preoperative, intraoperative, and postoperative factors across multiple sites is necessary to determine which patient or practice variations influence CT drainage patterns after CABG.
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Affiliation(s)
- Rochelle Wynne
- School of Nursing, Faculty of Health and Behavioural Sciences, Deakin University, Burwood, Australia
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Amarapurkar DN, Punamiya S, Patel ND. An experience with covered transjugular intrahepatic portosystemic shunt for refractory ascites from western India. Ann Hepatol 2006; 5:103-8. [PMID: 16807516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In refractory ascites/hydrothorax (RA), uncovered transjugular intrahepatic portosystemic shunt (TIPS) is shown to be superior to large-volume therapeutic paracentesis (LVP) for long-term control of ascites, but at a cost of increased risk of hepatic encephalopathy (HE). Use of covered TIPS has shown to improve shunt patency rate over uncovered TIPS. This retrospective analysis was performed on patients with RA to assess efficacy of TIPS, both covered and uncovered. METHODS Over 10-year period, patients with RA, patients either required LVP at least 2 times in a month, or were intolerant to LVP, or were unwilling to undergo further LVP, were treated with TIPS (Group-A = 12 patients with uncovered TIPS {Wallstent = 10, Memotherm = 1, SMART = 1}, age = 56.1 +/- 4.5 years, male: female = 5:1; Group-B = 11 patients with e-PTFE-covered TIPS {Viatorr = 11}, age = 55.8 +/- 5.2 years, male: female = 8:3). They were followed-up with clinical and ultrasonography/ Doppler examination every monthly for 3 months and every 3 monthly thereafter (mean = 9.6 +/- 4.2 months). Clinical success (disappearance of ascites at 1-month), technical success (post-TIPS reduction of portosystemic pressure gradient {PPG} < 12 mmHg), appearance of encephalopathy, TIPS-dysfunction (> 50% reduction in flow-velocity, > 50% shunt stenosis or increase in PPG > 12 mmHg in presence of symptoms) and mortality were noted. Data were analyzed using chi-square test and t test. RESULTS Baseline clinical and biochemical characteristics were similar in both groups. TIPS placement was possible in 11/12 group-A and 11/ 11 group-B patients. Fall in PPG after TIPS was similar in both groups. One patient in group-A was lost followup after the procedure. On comparison of group-A and group-B, clinical success (63.3% and 81.8%), technical success (90.9% and 100%), occurrence of HE (60% and 54.4%) and mortality at 1-year (70% and 63.3%) were not significantly different. TIPS-dysfunction requiring re-intervention was significantly more common in group-A (50%) than group-B (0%). CONCLUSIONS Covered TIPS was superior to uncovered TIPS, because of less TIPS-dysfunction without increasing chances of HE; but failed to offer any survival advantage.
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Affiliation(s)
- Deepak N Amarapurkar
- Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India.
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Knox EM, Kilby MD, Martin WL, Khan KS. In-utero pulmonary drainage in the management of primary hydrothorax and congenital cystic lung lesion: a systematic review. Ultrasound Obstet Gynecol 2006; 28:726-34. [PMID: 17001747 DOI: 10.1002/uog.3812] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To determine the effect of in-utero pulmonary drainage on perinatal survival in fetuses with primary hydrothoraces and/or congenital cystic lung lesions. METHODS Relevant papers were identified by searching MEDLINE (1966-2004), EMBASE (1988-2004) and the Cochrane Library (2004 issue 2). Studies were selected if the effect of prenatal pulmonary drainage (shunt, surgery or drainage) on perinatal survival was compared with no treatment, in fetuses with ultrasonic evidence of lung pathology. Study selection, quality assessment and data abstraction were performed independently and in duplicate. RESULTS Of a total number of 7958 articles, there were 16 controlled observational studies involving 608 fetuses. Study characteristics and quality were recorded for each study. Data were abstracted to generate 2 x 2 tables to compare the effect of pulmonary drainage vs. no drainage on perinatal survival. Pooled odds ratios (ORs) were used as summary measures of effect and the results were stratified according to predicted fetal prognoses. Pulmonary drainage did not improve perinatal survival in cystic lung lesions compared with no drainage (OR 0.56, 95% CI 0.32-0.97, P = 0.04) overall. However there was a marked improvement with this therapy in a subgroup of fetuses with fetal hydrops fetalis (OR 19.28, 95% CI 3.67-101.27, P = 0.0005) but not in the subgroup uncomplicated by fetal hydrops fetalis (OR 0.04, 95% CI 0.01-0.32, P = 0.002). CONCLUSION Percutaneous, in-utero pulmonary drainage in fetuses with ultrasonic evidence of congenital pulmonary cystic malformations was associated with improved perinatal survival among fetuses with hydrops fetalis and therefore poor predicted survival.
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Affiliation(s)
- E M Knox
- Division of Reproductive and Child Health, Birmingham Women's Hospital, University of Birmingham, Edgbaston, Birmingham, UK
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Saito R, Rai T, Saito H, Abe K, Takahashi A, Takiguchi J, Ohira H. [Two cases of intractable hepatic hydrothorax successfully treated with nasal CPAP]. Nihon Shokakibyo Gakkai Zasshi 2006; 103:1146-51. [PMID: 17023757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Hepatic hydrothorax is often resistant to various treatments. A failure in the treatment for hepatic hydrothorax may be associated with poor prognosis. We report two cases of intractable hepatic hydrothorax successfully treated by combining chemical pleurodesis using OK-432 with nasal continuous positive airway pressure. Combination therapy may provide a minimally invasive and effective treatment for intractable hepatic hydrothorax.
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Affiliation(s)
- Rie Saito
- Second Department of Internal Medicine, Fukushima Medical University School of Medicine
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Cerfolio RJ, Bryant AS. Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax. Ann Thorac Surg 2006; 82:457-9. [PMID: 16863743 DOI: 10.1016/j.athoracsur.2006.03.057] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Revised: 03/17/2006] [Accepted: 03/21/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with recurrent, refractory hepatic hydrothorax from porous diaphragm syndrome represent a therapeutic challenge with few options. METHODS A retrospective review of an electronic prospective database of patients with cirrhosis and refractory hepatic hydrothorax. Patients underwent video-assisted thoracoscopic surgery (VATS) with talc pleurodesis insufflating 2.5 g of talc. Successful therapy was defined as relief of dyspnea and control of symptomatic hydrothorax for a minimum of 6 months after the procedure. RESULTS There were 41 patients (21 men, median age 55 years), 25 with Child-Pugh class C and 14 with class B, and 2 liver transplant patients. The etiology of the cirrhosis was hepatitis B in 4, hepatitis C in 20, alcohol in 4, cryptogenic cirrhosis in 11, and other in 2. Definitive openings in the diaphragm were seen in only 2 patients. Seven patients (17%) required bedside talc slurry through the chest tube after the intraoperative talc. Overall success was achieved in 80% (33 of 41). Four patients experienced symptomatic fluid reaccumulation at 45, 61, 62, and 102 days and were treated with a repeat VATS, with success in 2. There was 1 operative death (coagulopathy). CONCLUSIONS Patients with recurrent effusions from porous diaphragm syndrome have few options. Video-assisted thoracoscopic surgery with talc is safe and successful in about three fourths of patients, but repeat talc slurry through the chest tube or repeat VATS is often needed. Video-assisted thoracoscopic surgery provides an effective alternative to transjugular intrahepatic portosystemic shunt and is a bridge toward liver transplantation in patients with few other options.
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Affiliation(s)
- Robert J Cerfolio
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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Van Mieghem T, Lewi L, Van Schoubroeck D, Oepkes D, De Boeck K, Devlieger R. Prenatal therapy for primary fetal hydrothorax in a dichorionic twin pregnancy. Prenat Diagn 2006; 26:584-6. [PMID: 16739234 DOI: 10.1002/pd.1458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lin DJ, Zhang M, Gao GX, Li B, Wang MF, Zhu L, Xue LF. Thoracoscopy for diagnosis and management of refractory hepatic hydrothorax. Chin Med J (Engl) 2006; 119:430-4. [PMID: 16542590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Affiliation(s)
- Dian-jie Lin
- Department of Respiratory Diseases, Shandong University Shandong Provincial Hospital, Jinan 250002, China.
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Abstract
Hepatic hydrothorax is a rare complication of portal hypertension secondary to liver cirrhosis affecting approximately 5-10% of cirrhotic patients with ascites. Hepatic hydrothorax results from an accumulation of fluid migrating through a diaphragmatic defect from the abdominal cavity into the pleural cavities. The effusion of hepatic hydrothorax is typically transudative whereas the effusion of spontaneous bacterial empyema (SBEM) is exudative. The clinical management of hepatic hydrothorax is equivalent to that of ascites. Patients with persistent hepatic hydrothorax despite fluid and sodium restriction as well as the use of maximally tolerable doses of diuretics and repeated thoracentesis are considered to have refractory hepatic hydrothorax. SBEM is a frequent underlying condition. SBEM occurs in up to 13% of patients with hepatic hydrothorax and should be treated by antibiotic therapy. Refractory hydrothorax is observed in 10% of patients with hepatic hydrothorax. These patients should be considered for transjugular intrahepatic portal systemic shunt (TIPS) placement which is the most effective option for refractory hepatic hydrothorax with response rates ranging up to 80% in most studies. Suitable patients with hepatic hydrothorax should be considered as candidates for liver transplantation. TIPS may help to bridge the time to liver transplantation.
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Affiliation(s)
- S Bozkurt
- Medizinische Klinik I-ZAFES, J.-W.-Goethe-Universität Frankfurt
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Mehra R, Huria A, Gupta P, Harsh M. Pseudo Meigs' syndrome with benign stromal hyperplasia and elevated CA-125. Indian J Med Sci 2006; 60:25-7. [PMID: 16444086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Fernando SK, Salzano R, Reynolds JT. Peritoneal dialysis-related hydrothorax--case report. Adv Perit Dial 2006; 22:158-61. [PMID: 16983961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. Here, we describe a case of hydrothorax in a peritoneal dialysis patient who underwent video-assisted thorascopic surgery and talc pleurodesis for a diaphragmatic defect to preserve peritoneal dialysis capabilities. We reviewed the literature for 2001-2005 to assess how others have handled this situation and whether patients have returned successfully to peritoneal dialysis.
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Affiliation(s)
- Sanjay K Fernando
- Internal Medicine, Department of Nephrology, Hospital of Saint Raphael, Connecticut, USA
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Rombolà F, Spinoso A, Ranieri FS, Bertuccio A, Del Giudice AC, Bertuccio SN. [Hydrothorax in absence of ascites: an unusual complication of hepatic cirrhosis with portal hypertension]. Clin Ter 2005; 156:179-81. [PMID: 16342519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
AIM Authors, describing a clinical case of hepatic hydrothorax in absence of ascites, analyse the disease physiopathology and their therapeutic options. PATIENTS AND METHODS Case report of a mixed aethiology (HCV and alcohol) hepatic cirrhosis, with pleural effusion, without ascites. CONCLUSIONS Hepatic hydrothorax without ascites is an uncommon complication of cirrhosis with portal hypertension. Treatment could be pharmacological, with diuretics administration, or operating. A simple and cheap method is thoracentesis. If hydrothorax relapses, most effective method is transjugular intrahepatic portosystemic shunt.
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Affiliation(s)
- F Rombolà
- Dipartimento di Medicina, Struttura Complessa di Malattie Infettive e Malattie del Fegato, Ospedale di Vibo Valentia.
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Abstract
PURPOSE OF REVIEW Hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) appears in approximately 2% of all patients. Recent advances in minimally invasive surgery have revolutionized the treatment strategy of this condition. RECENT FINDINGS Hydrothorax in CAPD is most commonly secondary to a pleuro-peritoneal communication. Thoracocentesis with biochemical analysis of pleural fluid is the first-line investigation. In uncertain cases, or when there is a clinical need to demonstrate the anatomy of the communication, an imaging approach such as peritoneal scintigraphy is required. Cessation of peritoneal dialysis is indicated if diagnosis of the complication is confirmed. For half of the cases, a conservative approach allows reinstitution of CAPD, presumably because of spontaneous resolution of the leakage. A small-volume exchange is a feasible alternative for children. In patients who failed conservative treatment, video-assisted thoracoscopic pleurodesis or diaphragmatic repair or both allows most of them to continue with CAPD. Chemical pleurodesis is probably indicated for those who failed conservative treatment in centers without video-assisted thoracoscopic support. Currently, only a minority of patients will require open thoracotomy. SUMMARY Once hydrothorax secondary to pleuro-peritoneal communication is confirmed in CAPD patients, temporary cessation of peritoneal dialysis remains the first-line treatment. Current evidence shows that video-assisted thoracoscopic pleurodesis or repair should be the treatment of choice in patients who failed conservative management.
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Affiliation(s)
- Cheuk Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Takahashi KI, Chin K, Sumi K, Nakamura T, Matsumoto H, Niimi A, Ikai I, Mishima M. Resistant hepatic hydrothorax: a successful case with treatment by nCPAP. Respir Med 2005; 99:262-4. [PMID: 15733499 DOI: 10.1016/j.rmed.2004.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Indexed: 11/23/2022]
Abstract
Hepatic hydrothorax is defined as pleural effusion with liver cirrhosis but no primary cardiopulmonary disease. Hepatic hydrothorax is often resistant to various therapeutic interventions. The most likely cause is the transfer of ascites fluid from the abdomen to the pleural space via the diaphragm because of a negative intrathoracic pressure gradient. A 62-year-old man was diagnosed with hepatoma and cirrhosis. After a partial hepatectomy, he suffered with hepatic hydrothorax. He had snoring without obvious sleep apnea. The patient's hepatic hydrothorax markedly improved following nasal continuous positive airway pressure (nCPAP) treatment during sleep. The mechanism for the improvement may have been the intrathoracic positive pressure during sleep induced by the nCPAP treatment during sleep. nCPAP treatment may provide a new therapy for resistant hepatic hydrothorax.
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Affiliation(s)
- Ken-ichi Takahashi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Abstract
A 53-year-old woman with a history of chronic alcoholism presented with symptomatic large right-sided pleural effusion with no evidence of ascites. After a diagnosis of hepatic hydrothorax was established, her symptoms improved with therapeutic thoracente
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Abstract
Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2-3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5-8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1-2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia. Hepatic hydrothorax is defined as a pleural effusion, usually >500 mL, in patients with cirrhosis without cardiopulmonary disease. The pathophysiology involves the direct movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. The estimated prevalence among cirrhotic patients is 5-10%. The effusion, which is a transudate, most commonly occurs in the right hemithorax. The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction and administration of diuretics. Refractory hydrothorax can be managed with transjugular intrahepatic portosystemic shunt in selected cases. Pleurodesis is not routinely recommended. Suitable patients with hepatic hydrothorax should be considered candidates for liver transplantation.
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Affiliation(s)
- A Cardenas
- Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Abstract
Hepatic hydrothorax is defined as the accumulation of significant pleural effusion in a cirrhotic patient without primary pulmonary or cardiac disease. Hydrothorax is uncommon occurring in up to 4-6% of all patients with cirrhosis and up to 10% in patients with decompensated cirrhosis. Although ascites is usually present, hydrothorax can occur in the absence of ascites. Patients with hepatic hydrothorax usually have advanced liver disease with portal hypertension and most of them will require liver transplantation. Over the last few years, new insights into the pathogenesis of this entity have lead to improved treatment modalities such as portosystemic shunts (TIPS) and video-assisted thoracoscopy for closure of diaphragmatic defects. These modalities may be of help as a bridge to transplantation. The aim of this review is to describe recent developments in the pathogenesis, diagnosis and treatment of hepatic hydrothorax.
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Affiliation(s)
- Chamutal Gur
- Liver Unit, Division of Medicine, Hadassah University Hospital, Jerusalem, Israel
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Szentkereszty Z, Kerekes L, Kotán R, Boland MG, Hallay J, Sápy P. [Non septic, surgical complications and their treatment of acute necrotizing pancreatitis in 131 cases]. Magy Seb 2004; 57:214-8. [PMID: 15570913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The authors analyse non septic, surgical complications and their treatment in 131 patients with acute necrotizing pancreatitis. Bleeding occurred in 13 patients 16 times. There were 3 cases with large intestine perforation, small intestine perforation twice in one patient and hydrothorax in 12 patients. The patients APACHE-II score was in the range of 15, 5, which was quite high. They experienced complications such as bleeding and bowel perforations mostly in those who underwent several reoperations. For the bleeding from acute duodenal ulcer conservative and surgical therapy (suturing) was executed. In the cases of intraabdominal bleeding they used several options such as, ligature, collagen mesh, Surgicell net and tamponation. Large intestine perforations were surgically treated with Hartmann's procedure or loop colostomy. The small intestine perforation was simply sutured. From the 12 patients with hydrothorax 8 underwent thoracic drainage. We lost 7 patients with bleeding, 3 with bowel perforations and 2 with hydrothorax. The authors believe that complications during therapy of acute necrotizing pancreatitis are high risk factor, but their treatment is not hopeless.
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Affiliation(s)
- Zsolt Szentkereszty
- Debreceni Egyetem Orvos- és Egészségtudományi Centrum II. sz. Sebészeti Klinika
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Cadranel JF, Jouannaud V, Duron JJ. Prise en charge d’un hydrothorax hépatique. Rev Mal Respir 2004; 21:621-36. [PMID: 15292860 DOI: 10.1016/s0761-8425(04)71372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- J-F Cadranel
- Unité d'Hépatologie, Service d'Hépato-Gastroentérologie et de Diabétologie, Centre Hospitalier Laennec, BP 72, 60109 Creil
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Girault-Lataste A, Abaza M, Valentin JF. Small volume APD as alternative treatment for peritoneal leaks. Perit Dial Int 2004; 24:294-6. [PMID: 15185781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Anne Girault-Lataste
- ARAUCO (Association Règionale d'Aide aux Urémiques du Centre Ouest), CHU de Tours, France
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