Hepatic hydrothorax

Abstract

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.

Outcomes of patients with chest tube insertion for hepatic hydrothorax

“…When ascites accumulate and intraperitoneal pressure increases, the pleuroperitoneal membrane ruptures and ascitic fluid can move into the low-pressure pleural space [2][3][4]. This explanation for the appearance of hepatic hydrothorax is supported by studies showing intraperitoneal-injected radiotracer activity in the pleural fluid of such patients [1].…”

“…Hepatic hydrothorax is an uncommon complication of chronic liver disease, occurring in 5-10% of patients with cirrhosis [1]. It is defined as a transudative effusion in patients with liver disease without a primary cardiopulmonary cause.…”

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

“…It is a relatively uncommon complication of end-stage liver disease, with an estimated prevalence among cirrhotic patients of 5% to 10% [1,[3][4][5] . Although the exact mechanisms involved in the development of HH have not been completely elucidated, the most widely accepted mechanism is the passage of fluid from the peritoneal to the pleural cavity through diaphragmatic defects, usually less than 1 cm in diameter [6][7][8][9] .…”

“…Hepatic hydrothorax (HH) is the accumulation of significant pleural effusion, usually in excess of 500 mL, in a patient with cirrhosis without coexisting primary cardiopulmonary disease [1][2][3] . It is a relatively uncommon complication of end-stage liver disease, with an estimated prevalence among cirrhotic patients of 5% to 10% [1,[3][4][5] .…”

The path to subcutaneous emphysema

“…Medicine Science International Medical Journal in cirrhotics commonly occurs on the right side and when > 500mL in the absence of cardiopulmonary, parenchymal disease or malignancy, is known as hepatic hydrothorax (HH), which is seen in 4 to 12% of cirrhotics. [1] It occurs due to passage of peritoneal fluid into the pleural cavity through varied sized diaphragmatic defects in the presence of negative intra-thoracic pressure during inspiration. Right sided effusions are common because of greater chances of development of these defects in the presence of weak diaphragmatic musculature on the right side, in comparison to the left.…”