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Hepatic hydrothorax.
John Paul Norvell1, James R Spivey1
1Division of Digestive Diseases, Department of Digestive Diseases, Department of Medicine, Emory Transplant Center, Emory University, 1365 Clifton Road, NE, Clinic B, Suite 1200, Atlanta, GA 30322, USA.
Clinics in Liver Disease
|April 1, 2014
Summary
Hepatic hydrothorax (HH) is a rare complication of end-stage liver disease, often caused by fluid transfer through diaphragmatic defects. Management includes diuretics, thoracentesis, and potentially a shunt, with liver transplantation as a consideration.
Area of Science:
- Hepatology
- Pulmonology
- Critical Care Medicine
Background:
- Hepatic hydrothorax (HH) is an infrequent but serious complication in patients suffering from end-stage liver disease (ESLD).
- This condition affects 5% to 10% of ESLD patients, leading to respiratory distress and increased mortality risk.
- The pathophysiology is primarily attributed to the translocation of peritoneal fluid into the pleural space via small diaphragmatic defects.
Purpose of the Study:
- To summarize the understanding of hepatic hydrothorax in end-stage liver disease.
- To outline the diagnostic and management strategies for HH.
- To emphasize the prognostic implications and treatment options, including liver transplantation.
Main Methods:
- Review of existing literature on hepatic hydrothorax in ESLD.
- Analysis of common clinical presentations and etiological factors.
- Summary of current therapeutic approaches and their efficacy.
Main Results:
- Hepatic hydrothorax presents with symptoms like dyspnea and hypoxia, indicating a poor prognosis.
- Diaphragmatic defects are the most common cause of fluid passage from the abdomen to the chest.
- Standard treatments include diuretics, sodium restriction, and thoracentesis, with transjugular intrahepatic portosystemic shunt (TIPS) as a potential intervention.
Conclusions:
- Hepatic hydrothorax is a significant complication of ESLD associated with high morbidity and mortality.
- Effective management requires a multi-faceted approach addressing fluid management and portal hypertension.
- Patients with HH should be evaluated for liver transplantation due to the severity and potential for fatal outcomes.
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