Hepatic Hydrothorax in the Absence of Clinical Ascites: Diagnosis and Management

Rubinstein, David; McInnes, I. E.; Dudley, F. J.

doi:10.1016/s0016-5085(85)80154-2

Cited by 149 publications

(98 citation statements)

References 11 publications

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“…This mechanism has been corroborated with nuclear medicine studies using [99Tcm]-human albumin or [99Tcm]-sulphur colloid and dye studies that show a unidirectional passage of these markers from the abdominal to the pleural cavity in the first 24 h after administration. [16][17][18] Other proposed mechanisms, which are mostly speculative, include an increase in azygous vein pressure and flow leading to leakage of plasma, 19 fluid traversing from the abdominal cavity to pleural space across transdiaphragmatic lymphatics, 20 hypoalbuminaemia with decreased colloid osmotic pressure 21 and leakage of the thoracic duct. 22 Although not specifically addressed in hepatic hydrothorax, the rate of reabsorption of ascites back into the intravascular compartment could also play an important role in the pathogenesis of hepatic hydrothorax.…”

Section: 12mentioning

confidence: 99%

Hepatic hydrothorax

Cárdenas

Kelleher

Chopra

2004

Aliment Pharmacol Ther

147

149

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SUMMARYPatients 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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Section: 12mentioning

confidence: 99%

Hepatic hydrothorax

Cárdenas

Kelleher

Chopra

2004

Aliment Pharmacol Ther

147

149

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“…The effusion, typically a transudate, most commonly occurs in the right hemithorax (85%) [3,10] . Ascites can be absent in up to 20% of patients with HH [11][12][13] . A diagnostic thoracentesis often confirms diagnosis and excludes infection.…”

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

Ditah¹

2015

WJH

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AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis. METHODS:A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I 2 test. RESULTS:Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%). CONCLUSION:TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis. Core tip: Evidence on the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in patients with refractory hepatic hydrothorax (RHH) is scarce and variable. This paper summarizes available data on the effectiveness of TIPSS in RHH in a cumulative meta-analysis. The sum total of the evidence shows that TIPSS is associated with a clinically relevant response in three-quarters of patients with medically RHH. We suggest that TIPSS be considered early in patients with RHH, given its impact on quality of life and prognosis. However, caution should be exercised in older patients and those with severe underlying liver or renal dysfunction.Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis. World

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“…However, even in these patients a one-way flow of radiolabelled colloid across the diaphragm has been demonstrated, suggesting that in these patients flow across the diaphragm matches the rate of ascites formation [33].…”

Section: Hepaticmentioning

confidence: 84%

The management of benign non-infective pleural effusions

et al. 2016

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The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations.Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting. @ERSpublications Benign pleural effusion management is challenging and based on limited evidence. Treatment options are discussed http://ow.ly/10EOSN

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Hepatic Hydrothorax in the Absence of Clinical Ascites: Diagnosis and Management

Cited by 149 publications

References 11 publications

Hepatic hydrothorax

Hepatic hydrothorax

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

The management of benign non-infective pleural effusions

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