Use of Denver shunt in recurrent hepatic hydrothorax

A 49-year-old woman with alcoholic cirrhosis was hospitalized for severe respiratory distress. A moderate amount of ascites was noted on physical examination, and the right hemithorax was completely opacified on the chest x-ray film. Thoracentesis was performed, and a follow-up chest x-ray film showed marked reduction of pleural effusion. Two days later the patient again was in respiratory distress, and a chest tube was inserted. On the tenth hospital day, a peritoneovenous (Denver) shunt was inserted and the chest tube was removed. Follow-up chest x-ray films showed almost complete resolution of pleural effusion, and the patient has remained free of symptoms. When hepatic hydrothorax does not respond to conventional therapy, we believe aggressive treatment with a Denver shunt may be successful. To our knowledge this procedure has been performed successfully in only one other patient. Further study is needed to assess its value as a possible alternative method of treatment.