Clinical criteria require a pleural effusion in the absence of primary. Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis in the absence of cardiopulmonary disease. Hepatic hydrothorax is an important and difficulttomanage complication of cirrhosis and portal hypertension. A pleural effusion associated with cirrhosis of the liver, typically on the right side of the chest, above the liver. Hepatic hydrothorax is defined as a transudative pleural effusion, usually greater than 500 ml in patients with portal hypertension without any other underlying primary cardiopulmonary cause. Hepatic hydrothorax hh is the excessive 500 ml accumulation of transudate in the pleural cavity in patients with decompensated liver. Hepatic hydrothorax without any evidence of ascites article pdf available in the scientific world journal 11. Portal hypertension is a complication of endstage liver disease. We report four observations of the development of pneumothorax exvacuo or trapped lung in the setting of hepatic hydrothorax. Another complication of hepatic hydrothorax is spontaneous bacterial empyema, which can happen around two percent of cirrhotic patients and can be seen in up to 16% when patients develop a hepatic hydrothorax 20. Pdf hepatic hydrothorax without any evidence of ascites. Hepatic hydrothorax without any evidence of ascites. After thoracentesis, diuretics should be started to prevent reaccumulation of fluid.
Transjugular intrahepatic portosystemic shunts and liver. Hepatic hydrothorax without clinical ascites is rare with only 10 reported cases. From 5% to 10% of cirrhotic patients with ascites develop hepatic hydrothorax, mainly in the right side almost 70% of the cases, but it can also be in the left side and bilateral. Hepatic hydrothorax is defined as the accumulation of ascitic fluid in the pleural space in a patient with cirrhosis, in whom a cardiac, pulmonary, or pleural cause has been excluded. However, complications occur frequently,1 and we wish to report a new onelife threatening acute hydrothorax developing during peritoneal dialysis. In one series of 60 patients with cirrhosis and a pleural effusion, a diagnosis other than hepatic hydrothorax was established in 18 patients 2. The mechanism of hepatic hydrothorax appears to be the passage of ascitic fluid through defects in the diaphragm. Men spreekt van een hepatische hydrothorax wanneer er bij patienten met levercirrose. Definition hepatic hydrothorax is defined as a significant pleural effusion usually greater than 500 ml in a cirrhotic patient without an underlying pulmonary or cardiac disease prevalence. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with a unilateral pleural effusion, most commonly right.
Apr 05, 2003 hepatic hydrothorax occurs in about 5% of patients with cirrhosis of the liver, depending on the criteria applied. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic. While patients with ascites can often tolerate up to 5 to 10 l of fluid with only mild symptoms, those with a pleural effusion can have severe symptoms such as shortness of breath, cough, and hypoxemia with as little as 500 ml of fluid. A large effusion hepatic hydrothorax occasionally appears during the course of the disease. Primary management options for these patients include serial thoracenteses, transjugular intrahepatic portosystemic shunt tips placement, and insertion of an indwelling pleural catheter ipc.
We present a case of hepatic hydrothorax in a patient with hepatitis c and liver cirrhosis that has no clinical. Pathogenesis, diagnosis, and management, abstract hepatic hydrothorax is defined as a pleural effusion in a patient with cirrhosis of the liver and no cardiopulmonary disease. The most likely cause is the transfer of ascites fluid from the abdomen to the pleural space via the diaphragm because of a negative intrathoracic pressure. Hepatic hydrothorax article about hepatic hydrothorax by. Hepatic hydrothorax is defined as a significant pleural effusion usually greater than 500 ml, in a cirrhotic patient, without an underlying pulmonary and cardiac. Hepatic hydrothorax hh is defined as an accumulation of fluid in the pleural space between the chest wall and the lung and occurs in 510% of patients with liver disease. The proposed theory of diaphragmatic fenestration in a patient with cirrhosis. The morphology of diaphragmatic defects in hepatic. Hepatic hydrothorax definition of hepatic hydrothorax by. Introduction the pleural space is bordered by the parietal and visceral pleurae that plays an important role in respiration by coupling the movement of the chest wall with that of the lungs in 2 ways. Apr 09, 20 hepatic hydrothorax is defined as a significant pleural effusion usually greater than 500 ml in a cirrhotic patient without an underlying pulmonary or cardiac disease. Written by dr sebastian zeki hepatic hydrothorax thoracentesis therapeutic thoracentesis is the most effective way of reducing large effusions 1.
Because the pressure in the pleural space is lower than the pressure in the abdominal cavity, fluid moves into the pleural space, and many patients with a hepatic hydrothorax have the entire hemithorax filled with fluid. Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 510% of patients with cirrhosis. It is one of the pulmonary complications of cirrhosis with portal hypertension it is characterized by formation of pleural effusions usually greater than 500 ml, in patients with portal hypertension without any other underlying primary cardiopulmonary cause 2. Report of a case a 68yearold man entered the hospital with. Only 5% to 10% of patients with endstage liver disease develop hh, which may result in dyspnea. Hepatic hydrothorax occurs in about 5% of patients with cirrhosis of the liver, depending on the criteria applied. However, complications occur frequently, 1 and we wish to report a new onelife threatening acute hydrothorax developing during peritoneal dialysis.
We discuss on the basis of gross videothoracoscopy. In a retrospective analysis of 495 patients with cirrhosis and pleural effusion, 16 percent had hepatic hydrothorax. Hepatic hydrothorax an unusal presentation of wilsons disease. It develops most likely because of diaphragmatic defects that allow for passage of fluid from the peritoneal space to the pleural space. Despite medical therapy with diuretics and salt restriction, many patients still experience intractable, debilitating shortness of breath, often necessitating hospital. Hepatic hydrothorax is defined as a significant pleural effusion, usually greater than 500 ml, in a cirrhotic patient,without an underlying pulmonary or cardiac disease. Ipc is emerging as a feasible alternative in patients who require frequent therapeutic thoracenteses. Severe ascites may be accompanied by hydrothorax, particularly on the right side, due to the transfer of the abdominal fluid to the chest through the thoracic duct. This condition is most likely to develop secondary to congestive heart failure, following an increase in hydrostatic pressure within the lungs. Hepatic hydrothorax is defined as a significant pleural effusion usually greater than 500 ml in a cirrhotic patient, without an underlying pulmonary or cardiac disease.
Hepatic hydrothorax is the development of a pleural effusion in a patient with liver disease in the absence of cardiopulmonary pathology, making it a diagnosis of exclusion in many cases. Obesity makes the physical examination less helpful in detecting ascites. Do not use a chest drain to treat hepatic hydrothorax when a patient presents with a large unilateral symptomatic pleural effusion many doctors will feel tempted to insert a chest drain. Garbuzenko dv contributed to the conception and design, acquisition, analysis and interpretation. Catheter placement for hepatic hydrothorax full text. Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. Hepatic hydrothorax is defined as a transudative pleural effusion, usually greater than 500 ml, in patients with portal hypertension without any other underlying primary cardiopulmonary cause. The most common symptoms are ascites and variceal hemorrhage, which develop in 47% and 25% of patients, respectively. Doraiswamy et al hepatic hydrothorax without ascites thescientificworldjournal 2011 11, 587591 591 conclusion although hepatic hydrothorax usually presents with ascites, there are rare cases when it does not. Almost all patients with hepatic hydrothorax also have ascites. It develops most likely because of diaphragmatic defects that allow for passage of fluid from the peritoneal space to. Accumulation of serous fluid in one or both pleural cavities.
Jeffries, sahira kazanjian, mark wilson, jeffrey punch, and robert j. Kevin korenblat, in blumgarts surgery of the liver, biliary tract and pancreas, 2volume set sixth edition, 2017. Hepatic hydrothorax hh is a complication in patients with cirrhosis and portal hypertension. Hepatic hydrothorax hh is an uncommon manifestation of cirrhosis with ascites. While patients with ascites can often tolerate up to 5 to 10 l of fluid with only mild symptoms, those with a pleural effusion can have.
The diagnosis of hepatic hydrothorax can be made in patients with cirrhosis and portal hypertension who develop large, usually right sided, pleural effusions in the absence of any primary cardiac, pulmonary, or pleural disease. Hepatic hydrothorax is a less common complication of portal hypertension, with a prevalence of. Light vanderbilt university, nashville, tennessee hepatic hydrothorax occurs in 510% of patients who have cirrhosis 1. Response rate to tips, being the first choice whenever possible, is about 80%. Hepatic hydrothorax is defined as a significant pleural effusion usually greater than 500 ml in a patient with cirrhosis of the liver but no evidence of primary cardiac or pulmonary disease 1,2.
Pneumothorax exvacuo or trapped lung in the setting of. It is a diagnosis of exclusion in cirrhotic patients with recurrent pleural effusions. Hepatic hydrothorax is often resistant to various therapeutic interventions. Hepatic hydrothorax accounts for 23% of all pleural effusion in this study. Aug 25, 2014 hepatic hydrothorax is defined as a transudative pleural effusion, usually greater than 500 ml in patients with portal hypertension without any other underlying primary cardiopulmonary cause. Catheter placement for hepatic hydrothorax full text view. Hepatic hydrothorax occurs in approximately 5 to 10 percent of patients with cirrhosis. Introduction to the revised american association for the. Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax mark a. Hepatic hydrothorax hh is an example of a porous diaphragm syndrome. Lesson of the week treating hepatic hydrothorax jakob borchardt, alona smirnov, lora metchnik, stephen malnick when a patient presents with a large unilateral symptomatic pleural effusion many doctors will feel tempted to insert a chest drain. A hydrothorax is a condition that results from fluid accumulating in the pleural cavity. The morphology of diaphragmatic defects in hepatic hydrothorax. Hepatic hydrothorax hh is the excessive 500 ml accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis lc but without cardiopulmonary and pleural diseases.
In fact, emerson in 1955 was the first to describe such a defect postmortem in a patient with hepatic hydrothorax. Hydrothorax article about hydrothorax by the free dictionary. More rarely, hydrothorax can develop in 10% of patients with ascites which is called hepatic hydrothorax. Report of a case a 68yearold man entered the hospital with renal failure of unknown cause and duration. In general, treatment focuses on symptomatic relief and prevention of respiratory compromise. Transjugular intrahepatic portosystemic shunt tips response rates in the range of 70 to 80 %. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic.
Jan 01, 20 hepatic hydrothorax is the development of a pleural effusion in a patient with liver disease in the absence of cardiopulmonary pathology, making it a diagnosis of exclusion in many cases. The pathophysiology involves the passage of ascitic fluid from the peritoneal cavity to the pleural space through diaphragmatic. A large effusion hepatic hydrothorax occasionally appears during. Hepatic hydrothorax hh is an uncommon complication in patients with endstage liver disease.
Annals of the american thoracic society ats journals. We caution against placement of a chest drain as a therapeutic reflex, par. Diaphragmoplasty with patch on the hepatic hydrothorax due to. Once alternative diagnosis have been excluded, to confirm the diagnosis, intraperitonial injection of 99m tcsulfur colloid of 99m tchuman serum albumin can be performed to. It can occur in patients with and without ascites and may be the first presenting symptom in patients with undiagnosed liver disease. Hepatic hydrothorax pratap sagar tiwari, dm resident department of hepatology, nams 2. The prognosis of hepatic hydrothorax is dismal with a median survival time of 812 months 8, 20. Here you can read posts from all over the web from people who wrote about ascites and hydrothorax, and check the relations between ascites and hydrothorax.
Hepatic hydrothorax is a relatively uncommon complication of cirrhosis, which generally portends a poor prognosis. Hydrothorax is a type of pleural effusion in which transudate accumulates in the pleural cavity. Peritoneal dialysis is a relatively safe and effective modern therapeutic procedure. Hepatic hydrothorax without clinical ascites shm abstracts. Hepatic hydrothorax with minimal ascites introduction hepatic hydrothorax is defined as a significant pleural effusion usually more than 500 ml that develops in a patient with liver cirrhosis and portal hypertension, in the absence of cardiopulmonary disease. Fontana hepatic hydrothorax is a relatively infrequent but potentially serious complication of. Acute hydrothoraxa new complication of peritoneal dialysis. In hemothorax this fluid is blood as in major chest injuries, in pyothorax the fluid is pus resulting from chest infections, in chylothorax it is lymph fluid resulting from rupture of the thoracic duct.
Hepatic hydrothorax is a major pulmonary complication of end stage liver disease esld. Hepatic hydrothorax is defined as a recurrent pleural effusion in patients with endstage liver disease and portal hypertension in the absence of comorbid cardiac or pulmonary disease. The estimated prevalence among patients with liver cirrhosis is approximately 56%. We caution against placement of a chest drain as a therapeutic reflex, particularly if the diagnosis is hepatic hydrothorax. Hepatic hydrothorax is defined as pleural effusion with liver cirrhosis but no primary cardiopulmonary disease. Primary management options for these patients include serial thoracenteses. A challenging case of refractory hepatic hydrothorax. Prevalence, risk factors, and inhospital outcome of pleural effusion. Fontana hepatic hydrothorax is a relatively infrequent but potentially serious complication of cirrhosis re. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. To discuss the role of peritoneal scintigraphy as a simple non invasive method providing proof of a communication between the pleural and peritoneal spaces. The mechanism of hepatic hydrothorax appears to be the passage of ascitic. The pathophysiology involves the passage of ascitic fluid from the peritoneal cavity to the pleural space through diaphragmatic defects.
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