Pleural Effusion in Liver Disease

Alonso, José Castellote

doi:10.1055/s-0030-1269829

Cited by 42 publications

(41 citation statements)

References 47 publications

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“…When symptomatic HH fails to respond to medical treatment, repeat thoracentesis is often undertaken. Although thoracentesis is less invasive than TIPSS and is effective in quickly relieving symptoms of dyspnea, it can be associated with complications such as re-expansion pulmonary edema, pneumothorax, and empyema [5,30] . Repeated thoracentesis is also associated with deteriorating clinical status and poor quality of life [1,6] .…”

Section: Ref Methods and Patients Outcomes/complications Remarksmentioning

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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Section: Ref Methods and Patients Outcomes/complications Remarksmentioning

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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“…3 while awaiting culture result [9,6] . Chest Tube drainage is contraindicated in patients with hepatic hydrothorax and SBEM because of the risk of life threatening fluid depletion, protein loss and electrolyte imbalance [10,3] .…”

Section: Cells/mmmentioning

confidence: 99%

“…It has been reported to be present in 10% -20% of hospitalized patients with hepatic hydrothorax [3][4][5] . SBEM can occur either with SBP, through trans-diaphragmatic spread, or without SBP through hematogenous spread [6] . Some factors may contribute to development of SBEM in patients with cirrhosis such as the presence of SBP, low pleural fluid protein and complement (C3) levels, low serum albumin and advanced liver disease (high child pugh score) [4,7] .…”

Section: Introductionmentioning

confidence: 99%

Study of Frequency of Spontaneous Bacterial Empyema in Cirrhotic Patients With Hepatic Hydrothorax

Emam

Ibrahim

Galal

et al. 2015

Journal of Gastroenterology and Hepatology Research

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AIM:The aim of this work was to assess the frequency of spontaneous bacterial empyema in cirrhotic patients with ascites and determine the possible associated risk factors of spontaneous bacterial empyema in those patients. MATERIALS AND METHODS: 322 cirrhotic patients with ascites and pleural effusion were enrolled. Spontaneous bacterial empyema was diagnosed by positive pleural fluid culture or, if negative, a pleural fluid PMNL count >500 cells/mm3 without radiographic evidence of pneumonia or a contiguous infection process on chest radiography. RESULTS: The frequency of spontaneous bacterial empyema (SBEM) among cirrhotic patients with ascites and hepatic hydrothorax was 14.3% (46 out of 322 cirrhotic patients). E.Coli was the commonest organism (54.8%) responsible for SBEM in positive culture cases. CONCLUSION: SBEM was recognized in 14.3% of cirrhotic patients with ascites and hepatic hydrothorax. So, it is a frequent but underdiagnosed complication of hepatic hydrothorax and has a poor prognosis.

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“…The predominant mechanism leading to a pleural effusion in a patient with cirrhosis and ascites is the movement of ascitic fluid through a diaphragmatic defect into the pleural space. 23 At times, the ascites may not be apparent clinically. The initial management of the pleural effusion associated with cirrhosis and ascites should be directed toward treatment of the ascites with a low-salt diet and diuretics.…”

Section: Cirrhosismentioning

confidence: 99%

Pleural Effusions

Light¹

2011

Medical Clinics of North America

206

153

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There are many diseases that cause pleural effusions. When a patient with a pleural effusion is first evaluated, one should determine if the patient has a transudate or an exudate. A diagnostic approach to the patient with an undiagnosed pleural effusion is outlined. The most common pleural effusions including those caused by congestive heart failure, cirrhosis, pneumonia, malignancy, tuberculosis, lupus erythematosus, rheumatoid disease, and chylothorax are discussed.

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Pleural Effusion in Liver Disease

Cited by 42 publications

References 47 publications

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

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

Study of Frequency of Spontaneous Bacterial Empyema in Cirrhotic Patients With Hepatic Hydrothorax

Pleural Effusions

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