Hepatic hydrothorax

Abstract

A hepatic hydrothorax is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. The pleural effusion is derived from ascitic fluid that enters the chest because of the negative pressure within the pleural space via defects in the diaphragm. The peritoneal-to-pleural flow of fluid can be demonstrated by nuclear scanning, even when the ascites is not clinically apparent. The pleural fluid usually has the characteristics of a transudate. However, an occasional patient with hepatic hydrothorax will develop spontaneous bacterial pleuritis manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. Treatment of the hydrothorax is directed at the underlying liver disease but a dyspneic patient can obtain relief from a thoracentesis or paracentesis. When medical therapy fails, liver transplantation is the treatment of choice. Both transjugular intrahepatic portosystemic shunting and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality of these procedures are high because of the fragile nature of the patients.

The impact of preoperative hepatic hydrothorax on the outcome of adult liver transplantation

“…It has been suggested that the most likely cause of hepatic hydrothorax is the direct passage of ascitic fluid from the peritoneal cavity to the pleural cavity through anatomical diaphragmatic defects [4,5]. Interestingly, tense peritoneal ascites is not constant in patients with hepatic hydrothorax [5][6][7]. Hepatic hydrothorax develops as a consequence of increased sodium retention.…”

“…The major risk of this procedure is pneumothorax, especially with serial thoracentheses [6]. Transjugular intrahepatic portosystemic shunt (TIPS) is the procedure of choice in patients with hepatic hydrothorax who do not respond to diuretic and thoracentheses [7,11]. However, serious complications are related to TIPS placement.…”

X-Ray of One-Sided “White Lung” after Central Venous Catheterization

“…Hepatic hydrothorax is a rare but important cause of—usually unilateral—pleural effusion. About 85–90% of the cases are isolated right-sided effusions [6]. Hepatic hydrothorax can be observed as a complication of portal hypertension in <10% of patients with ascites secondary to advanced liver cirrhosis.…”

Treatment of hepatic hydrothorax with terlipressin in a cirrhotic patient

“…Treatment of HH is difficult and sodiumfluid restriction and diuretics are often not sufficient [2]. TIPS and liver transplantation may be a good choice for elective cases [6,9,10]. Repeated thoracenteses and chest tube insertion are also unsatisfactory because of the high risk of complications and recurrence of hydrothorax [8].…”