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Related Experiment Videos

[Hepatic hydrothorax].

J J Kuiper1, R A de Man, H R van Buuren

  • 1Erasmus MC-Centrum, afd Maag-, Darm- en Leverziekten, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|June 14, 2006
PubMed
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Hepatic hydrothorax, a complication of liver cirrhosis, presents as pleural effusions without heart or lung disease. Early diagnosis and appropriate management, avoiding prolonged chest drainage, are crucial for patient survival.

Area of Science:

  • Hepatology
  • Pulmonology
  • Internal Medicine

Background:

  • Hepatic hydrothorax is a significant complication of advanced liver cirrhosis.
  • It involves pleural fluid accumulation, often without concurrent ascites.
  • Cardiopulmonary diseases must be ruled out to diagnose hepatic hydrothorax.

Observation:

  • Four patients with liver cirrhosis presented with unilateral or bilateral pleural effusions.
  • One patient without ascites was initially misdiagnosed, leading to fatal complications from chest tube drainage.
  • Other patients experienced complications like renal failure and encephalopathy due to chest tube use.

Findings:

  • Hepatic hydrothorax should be suspected in cirrhotic patients with pleural effusions, even without ascites.

Related Experiment Videos

  • A pleural fluid to serum albumin gradient greater than 11 g/l is characteristic.
  • Prolonged chest tube drainage is associated with severe complications and should be avoided.

    • Implications:

    • Prompt diagnosis and management are vital, as absence of ascites can delay recognition.
    • Transjugular intrahepatic portosystemic shunt (TIPS) is the preferred treatment for refractory cases.
    • Emerging therapies include pleurodesis combined with thoracoscopic repair of diaphragmatic defects.