Pleural Fluid Analysis and Radiographic, Sonographic, and Echocardiographic Characteristics of Hepatic Hydrothorax

Gurung, Puncho; Goldblatt, Mark R.; Huggins, John T.; Doelken, Peter; Nietert, Paul J.; Sahn, Steven A.

doi:10.1378/chest.10-2134

Cited by 47 publications

(45 citation statements)

References 20 publications

(20 reference statements)

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“…A PMN > 500 cells/mm 3 is diagnostic for SBPL in a pleural effusion, although SBPL with PMN between 250-500 cells/mm 3 is documented by positive pleural fluid culture [76] . Chest tube placement is contraindicated in SBPL, in the absence of empyema, due to the risk of protein loss, prolonged drainage, secondary infection and hepatorenal syndrome [77] . Treatment of HH includes the restriction of sodium intake with the administration of diuretics.…”

Section: Portal Hypertensionmentioning

confidence: 99%

“…Treatment of HH includes the restriction of sodium intake with the administration of diuretics. This approach is effective in controlling HH, although fluid mobilization from the pleural cavity may be slower than from the peritoneal cavity and approximately 20% of patients develop refractory HH [77] . Percutaneous drainage, and chest tube placement can be used in some cases [77,78] .…”

Section: Portal Hypertensionmentioning

confidence: 99%

“…This approach is effective in controlling HH, although fluid mobilization from the pleural cavity may be slower than from the peritoneal cavity and approximately 20% of patients develop refractory HH [77] . Percutaneous drainage, and chest tube placement can be used in some cases [77,78] . The standard of care treatment for refractory HH is TIPS placement with response rates of 70% to 80% [79,80] .…”

Section: Portal Hypertensionmentioning

confidence: 99%

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Hepato-cardiac disorders

Fouad¹,

Yehia²

2014

WJH

111

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Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato�cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. �ifferential diagnoses of liver injury are extremely important in a cardiologist's clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic conges� tive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplanta� tion may lead to the improvement of all cardiac chang� es and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases

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Section: Portal Hypertensionmentioning

confidence: 99%

Section: Portal Hypertensionmentioning

confidence: 99%

Section: Portal Hypertensionmentioning

confidence: 99%

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Hepato-cardiac disorders

Fouad¹,

Yehia²

2014

WJH

111

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“…Sometimes cirrhotic patients present primarily with pulmonary complaints related to hydrothorax [29,30,31,32]. Isolated hydrothorax without any clinical ascites has been reported in about 20% of patients [33,] but when both computed tomography (CT) and ultrasonography were used, it was found in 7% of the patients [34]. …”

Section: Clinical Presentationmentioning

confidence: 99%

“…HH is transudative in nature. In a retrospective study of 41 HH patients, solitary HH was found in 33 patients [34]. Of these 33 patients, 31 (94%) were transudates.…”

Section: Diagnosismentioning

confidence: 99%

Evidence-Based Review of the Management of Hepatic Hydrothorax

Singh¹,

Bajwa²,

Shujaat³

2013

Respiration

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Hepatic hydrothorax (HH) is an example of a porous diaphragm syndrome. Portal hypertension results in the formation of ascitic fluid which moves across defects in the diaphragm and accumulates in the pleural space. Consequently, the treatment approach to HH consists of measures to reduce the formation of ascitic fluid, prevent the movement of ascitic fluid across the diaphragm, and drain or obliterate the pleural space. Approximately 21-26% of cases of HH are refractory to salt and fluid restriction and diuretics and warrant consideration of additional treatment measures. Ideally, liver transplantation is the best treatment option; however, most of the patients are not candidates and most of those who are eligible die while waiting for a transplant. Treatment measures other than liver transplantation may not only provide relief from dyspnea but also improve patient survival and serve as a bridge to liver transplantation.

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Pulmonary complications in chronic liver disease

2014

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The association of chronic liver disease with respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease have been characterized: hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax (HH). The development of portal hypertension is fundamental in the pathogenesis of each of these disorders. HPS is the most common condition, found in 5%-30% of cirrhosis patients, manifested by abnormal oxygenation due to the development of intrapulmonary vascular dilatations. The presence of HPS increases mortality and impairs quality of life, but is reversible with liver transplantation (LT). POPH is characterized by development of pulmonary arterial hypertension in the setting of portal hypertension, and is present in 5%-10% of cirrhosis patients evaluated for LT. Screening for POPH in cirrhosis patients eligible for LT is critical since severe POPH is a relative contraindication for LT. Patients with moderate POPH, who respond adequately to medical therapy, may benefit from LT, although sufficient controlled data are lacking. HH is a transudative pleural effusion seen in 5%-10% of cirrhosis patients, in the absence of cardiopulmonary disease. Diagnosis of HH should prompt consideration for LT, which is the ultimate treatment for HH. Conservative management includes salt restriction and diuretics, with thoracentesis and transjugular intrahepatic portosystemic shunt (TIPS) as second-line therapeutic options. (HEPATOLOGY 2014;59:1627-1637 Hepatopulmonary SyndromeThe hepatopulmonary syndrome (HPS) is defined by an oxygenation defect caused by the development of intrapulmonary vascular dilatation (IPVD) in patients with either advanced liver disease and/or portal hypertension. Impaired oxygenation in HPS is reflected by a widened age-corrected alveolar-arterial oxygen gradient (P[A-a]O 2 ) on room air, with or without hypoxemia. 1 Cirrhosis, irrespective of the underlying cause, is the most common hepatic condition associated with HPS. However, HPS may also develop in noncirrhotic portal hypertension and ischemic hepatitis.2,3 HPS may occur in patients with coexisting cardiopulmonary conditions and further exacerbate existing respiratory symptoms and hypoxemia in these patients. 4 PathogenesisThe appearance of IPVD underlies the development of HPS. This vascular abnormality consists of diffuse or localized dilated abnormal pulmonary capillaries and, less commonly, pleural and pulmonary arteriovenous communications which result in impaired oxygenation of venous blood as it passes through the pulmonary circulation.5 Nitric oxide (NO), a potent vasodilator, has been linked to IPVD. Increased levels of exhaled NO derived from the lung are seen in cirrhosis patients with HPS, which normalize after liver transplantation (LT). 6Chronic common bile duct ligation in the rat results in biliary cirrhosis, and recapitulates the physiologic changes of human HPS. The majority of what is Abbreviations: ABG, arterial blood gas; ...

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Pleural Fluid Analysis and Radiographic, Sonographic, and Echocardiographic Characteristics of Hepatic Hydrothorax

Abstract: Abbreviations: ANC 5 absolute neutrophil count; BNP 5 brain natriuretic peptide; LDH 5 lactate dehydrogenase; TIPS 5 transjugular intrahepatic portosystemic shunt

Cited by 47 publications

References 20 publications

Hepato-cardiac disorders

Hepato-cardiac disorders

Evidence-Based Review of the Management of Hepatic Hydrothorax

Pulmonary complications in chronic liver disease

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