Management of ascites and hepatic hydrothorax

Cárdenas, Andrés; Arroyo, Vicente

doi:10.1016/j.bpg.2006.07.012

Cited by 37 publications

(19 citation statements)

References 82 publications

(73 reference statements)

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“…18 Previous studies have reported that the prevalence of pleural effusion in patients with endstage liver disease ranged from 5% to 10%. 19,20 Pleural effusion was found in 16.3% of our study patients, which is consistent with the literature. Cardenas and associates and Lazaridis and associates found pleural effusion involving the right lung in 85% of patients, whereas Reichen and associates found pleural effusion involving the right lung in 65% of patients.…”

Section: Discussionsupporting

confidence: 92%

Untitled

2014

Exp Clin Transplant

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Objectives: The purpose of this retrospective study was to determine the rate of occurrence and features of pleural effusion in patients referred to our institution for liver transplant. Materials and Methods: This study included 135 patients (43 women, 92 men) with a mean age of 40 years (range, 16-66 y). Patient characteristics such as history of pulmonary disease and types of respiratory symptoms were recorded. The chest radiographs of every study patient were examined. Results: Of the 135 study patients, 16 (11.9%) had respiratory symptoms upon admission to the hospital, and 49 (36.3%) had abnormalities on their chest radiographs. The most common radiographic abnormality was elevated right hemidiaphragm in 32 patients (23.7%), followed by pleural effusion in 22 (16.2%), atelectasis in 21 (15.5%), hilar enlargement in 18 (13.3%), and elevated left hemidiaphragm in 9 (6.6%). Seventeen of 22 patients (77.3%) had right pleural effusion, 4 (18.2%) had bilateral, and 1 (4.5%) had left pleural effusion. Of the 10 patients undergoing thoracentesis, 9 had transudates and 1 had an exudate. Conclusions: Preoperative pleural effusion is a common problem in patients who are candidates for a liver transplant. Most of these patients have right transudative pleural effusion.

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Section: Discussionsupporting

confidence: 92%

Untitled

2014

Exp Clin Transplant

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“…The appearance of significant hepatic hydrothorax poses an increased risk for respiratory infections, renal failure, and mortality. It is estimated that nearly a half of patients who have a poor prognosis will die in approximately two years without transplantation (Cárdenas and Arroyo, 2007). From our experiences, treatment failure after VATS pleurodesis is related to the severity of liver dysfunction and the degree of portal hypertension, which will influence the rate of ascites accumulation.…”

Section: Fig3 Demographic Information and Previous Strategies Of Thementioning

confidence: 97%

Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases

Luh

Chen

2009

J. Zhejiang Univ. Sci. B

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Abstract:Background: Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods: Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery (VATS). Repair of the diaphragmatic defects, or pleurodesis by focal pleurectomy, talc spray, mechanical abrasion, electro-cauterization or injection was administered intraoperatively, and tetracycline intrapleural injection was used postoperatively for patients with prolonged (>7 d) high-output (>300 ml/d) pleural effusion. Results: Out of the 12 patients, 8 (67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4 (33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion: We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.

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“…It is a relatively uncommon complication of end-stage liver disease, with an estimated prevalence among cirrhotic patients of 5%-10% (23). The most accepted theory explaining the pathophysiology is leakage of ascitic fluid via a diaphragmatic defect (Fig 7).…”

Section: Hepatic Hydrothoraxmentioning

confidence: 99%

Thoracic Complications of Liver Cirrhosis: Radiologic Findings

Kim¹,

Kim²,

Shim³

2009

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Patients with chronic liver disease exhibit various cardiovascular and pulmonary complications. Hepatopulmonary syndrome results in dyspnea due to intrapulmonary arteriovenous shunting and ventilation-perfusion mismatch. Portopulmonary hypertension occurs in patients with portal hypertension. Intrathoracic portosystemic collateral vascular pathways develop in patients with portal hypertension to allow decompression of the portal vein into the systemic circulation. Hepatic hydrothorax may develop in patients with cirrhosis and ascites. Massive necrosis of the liver from any cause may be associated with acute hypoxic respiratory failure, necessitating ventilatory support. Bacterial infection is common in cirrhotic patients because of a compromised host defense system. Hepatocellular carcinoma may produce hematogenous lung metastases, intrathoracic lymph node metastases, direct intracardiac extension, and pulmonary embolism. Interferon therapy for treatment of chronic active hepatitis C may disturb cellular immune activation in some patients and contribute to the onset and progression of sarcoidosis. Awareness of the various thoracic manifestations in chronic liver disease can be helpful for making a differential diagnosis and planning proper management.

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Management of ascites and hepatic hydrothorax

Cited by 37 publications

References 82 publications

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Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases

Thoracic Complications of Liver Cirrhosis: Radiologic Findings

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