Hepatic Hydrothorax without Any Evidence of Ascites

Doraiswamy, Vikram; Riar, Sandeep; Shrestha, Pranabh; Pi, Justin; Alsumrain, Mohammad; Bennet-Venner, Arianne; Kam, Jennifer C.; Klukowicz, Alan; Miller, R. Drew

doi:10.1100/tsw.2011.68

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…The pathophysiology underlying hepatic hydrothorax remains incompletely understood. 4 , 6 , 14 , 15 , 31 , 35 The most common view is that the pleural effusion arises from the passage of peritoneal fluid into the pleural cavity through varied size diaphragmatic defects assisted by negative intrathoracic pressure resulting from inspiration. 4 , 31 This mechanism presupposes that in situations where there is no ascites, there is complete equilibrium between the amount of ascites produced and that present in the pleural space; this is consistent with previous reports.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 31 This mechanism presupposes that in situations where there is no ascites, there is complete equilibrium between the amount of ascites produced and that present in the pleural space; this is consistent with previous reports. 4 , 6 , 14 , 31 , 33 …”

Section: Discussionmentioning

confidence: 99%

“… 10 , 31 , 33 It is thought to be most common in patients with cirrhosis and severe ascites, but there are reports of hydrothorax in patients with little to no ascites. 6 , 10 , 14 , 15 , 35 …”

Section: Introductionmentioning

confidence: 99%

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Hepatic Hydrothorax

2014

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hepatic Hydrothorax

2014

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“…During raised intra-abdominal pressure as in coughing, vomiting and ascites, the rupture of bleb occurs which causes leakage of ascitic fluid in the pleural spaces. 13 The negative intrathoracic pressure during inspiration helps to accumulate the ascitic fluid in the pleural cavity. Other explanations are the reduced colloid osmotic pressure due to hypoalbuminemia, increased azygos venous pressure and leakage of plasma into the pleural cavity, transmigration of peritoneal fluid into the pleural cavity through lymphatic channel.…”

Section: Dr Rana Kumar Biswasmentioning

confidence: 99%

A 9-year-old girl presented with jaundice, abdominal distension, hematemesis, melena and pleural effusion

Marjan¹,

Rukunuzzaman²,

Karim³

et al. 2018

Bangabandhu Sheikh Mujib Medical Univ J

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This article has no abstract. The first 100 words appear below: A 9-year-old girl of non-consanguineous parents presented at the outpatient department with the history of jaundice and abdominal distension for 20 days and respiratory distress for 7 days. She also complained of bloody vomiting without any melena. The mother gave the history of abdominal pain for 2 days which was diffuse in nature. Her menarche had not started yet. Her younger sister is healthy. She had no history of fever, constipation, family history of liver disease, sib death, contact with known tuberculosis patient, blood transfusion or parenteral medication. On examination, she was afebrile, moderately pale, dyspnea and leukonychia. Bilateral pedal edema was present.

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“…Rarely the left sided effusion may occur, it can even occur in the absence of ascites as well. 6,7 Development of pleural effusion involves several mechanisms in cirrhotic patients, change in splanchnic circulation, rise in the concentration of nitric oxide (NO) in splanchnic circulation, decrease albumin concentration in blood, increased flow along with raised pressure in thoracic duct, and azygos veins and portal hypertension are usual in patients having cirrhosis and these all are the main contributor in the development of ascites and pleural effusion. 8 Cardenas et al 2004 explains the development of hepatic hydrothorax, which occurs when ascetic fluid ascends upwards through diaphragmatic defects from the peritoneal cavity.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Bacterial Empyema in Cirrhotic patients with Hepatic hydrothorax.

Memon

Maheshwari

Lakho

et al. 2020

TPMJ

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Objectives: To determine the frequency of spontaneous bacterial empyema in cirrhotic patients with hepatic hydrothorax. Study Design: Descriptive cross sectional study. Setting: Conducted in gastroenterology unit at Isra University Hospital, Hyderabad. Periods: One year from April 2016 to March 2017. Material & Methods: Sample of 174 patients of Hepatic Hydrothorax was taken. Patients were of both gender and age ≥ 18 years, having diagnosed cirrhosis since last 5 years and currently having child class B & C severity were included. Hepatic hydrothorax was confirmed on ultrasound chest. After aseptic measures 50ml of pleural fluid was aspirated and sent to Isra University Hospital laboratory following the ultrasound guidelines. Spontaneous bacterial empyema was assessed as “polymorph nuclear cell count” more than 500 cells/mm3 or +ve culture with PMN cell count more than 250 cells/mm3 without parapneumonic effusion. All the data was recorded in the proforma. Results: The mean ± SD age of patients was 53.52 ± 5.52 years. Males were 60.92% while 39.08% were females. The frequency of spontaneous bacterial empyema was about 14.9%. Frequency of spontaneous bacterial empyema was little more in male gender than females (p value = 0.391), while it was significantly increased with increasing age as most common in age group of 61-65 years (p-value = 0.017). Conclusion: It was concluded that spontaneous bacterial empyema in cirrhosis patients was 14.9%.

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Hepatic Hydrothorax without Any Evidence of Ascites

Cited by 9 publications

References 10 publications

Hepatic Hydrothorax

Hepatic Hydrothorax

A 9-year-old girl presented with jaundice, abdominal distension, hematemesis, melena and pleural effusion

Spontaneous Bacterial Empyema in Cirrhotic patients with Hepatic hydrothorax.

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