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An Unexpected Hepatic Hydrothorax After a Successful Kasai Portoenterostomy: A Case Report
Giulia Ranucci1, Fabiola Di Dato1, Daniela Liccardo2
1Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.
Insights
Hepatic hydrothorax (HH), a rare complication of portal hypertension, occurred in a pediatric biliary atresia patient. This case highlights HH as a potential indicator for liver transplantation in children with respiratory distress.
Area of Science:
- Pediatric Hepatology
- Pulmonology
- Gastroenterology
Background:
- Hepatic hydrothorax (HH) is a known complication of portal hypertension in adults with cirrhosis.
- Biliary atresia is a severe liver disease in infants that can lead to portal hypertension.
Observation:
- A pediatric case of HH was observed in an infant with biliary atresia.
- The infant presented with recurrent right-sided pleural effusion post-Kasai portoenterostomy.
- The patient showed no overt signs of hepatic failure but experienced recurrent HH.
Findings:
- Hepatic hydrothorax can occur in children, even without advanced liver failure.
- Recurrent HH prompted liver transplantation in this pediatric patient with a low PELD score.
- Portal hypertension and respiratory distress are key indicators for suspecting HH in pediatric patients.
Implications:
- This case expands the understanding of HH presentation in pediatric patients.
- HH should be considered in the differential diagnosis of respiratory distress in children with portal hypertension.
- Liver transplantation may be a necessary treatment for refractory hepatic hydrothorax in pediatric cases.
Abstract:
Hepatic hydrothorax (HH) represents a rare complication of portal hypertension among adult cirrhotic patients. Here, we describe a pediatric case of HH, observed in a biliary atresia infant. The child presented with recurrent right-sided pleural effusion, after a successful Kasai portoenterostomy with restoration of bile flow and without overt signs of hepatic failure. Recurrence of HH led the patient to liver transplant despite a low pediatric end-stage liver disease value. Although rare, HH can also occur in children and should be suspected in patients with portal hypertension and respiratory distress. HH may be an indication for liver transplantation.
