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Hepatic hydrothorax.

Gary T Kinasewitz1, Jean I Keddissi

  • 1Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA. gary-kinasewitz@ouhsc.edu

Current Opinion in Pulmonary Medicine
|June 14, 2003
PubMed
Summary

Hepatic hydrothorax, a pleural effusion in cirrhosis patients, stems from ascites crossing diaphragmatic defects. Treatment focuses on liver disease, with transplantation as the definitive option.

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Area of Science:

  • Hepatology
  • Pulmonology
  • Gastroenterology

Background:

  • Hepatic hydrothorax is a type of pleural effusion occurring in cirrhosis patients with portal hypertension.
  • It arises from ascitic fluid traversing diaphragmatic defects into the pleural space due to negative intrathoracic pressure.
  • This condition develops in the absence of underlying heart or lung disease.

Purpose of the Study:

  • To elucidate the pathophysiology of hepatic hydrothorax.
  • To describe diagnostic methods and treatment strategies for this condition.
  • To evaluate the efficacy and risks of various interventions.

Main Methods:

  • Review of existing literature on hepatic hydrothorax.
  • Discussion of diagnostic techniques, including nuclear scanning for peritoneal-to-pleural fluid flow.
  • Analysis of treatment options, ranging from medical management to surgical interventions.

Main Results:

  • Pleural fluid typically exhibits transudative characteristics.
  • Spontaneous bacterial pleuritis can occur, necessitating antibiotic therapy.
  • Peritoneal-to-pleural fluid flow is demonstrable even with subclinical ascites.

Conclusions:

  • Management targets the underlying liver disease.
  • Symptomatic relief can be achieved through thoracentesis or paracentesis.
  • Liver transplantation is the preferred treatment for refractory cases, while TIPS and thoracoscopic procedures offer palliation with significant risks.

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