A difficult pleural effusion in a cirrhotic patient

Jackson, Karl; Johnston, Robert; Mackay, Laura; Aujayeb, Avinash

doi:10.1183/20734735.0049-2020

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…As outlined above, the pathophysiology of HH principally relates to the direct migration of ascitic fluid into the pleural cavity through diaphragmatic defects, most commonly within the right hemidiaphragm. Medical thoracoscopy can be used to interrogate the pleura for the presence of adhesions and non-expandable lung, diaphragmatic defects, and to explore the possibility of alternative diagnoses [52]. However, its use in HH is not widespread, and has not been formally evaluated.…”

Section: Video-assisted Thoracoscopy and Diaphragmatic Repairmentioning

confidence: 99%

Hepatic Hydrothorax: A Narrative Review

et al. 2022

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Hepatic hydrothorax (HH) represents a distinct clinical entity within the broader classification of pleural effusion that is associated with significant morbidity and mortality. The median survival of patients with cirrhosis who develop HH is 8-12 months. The diagnosis is typically made in the context of advanced liver disease and ascites, in the absence of underlying cardiopulmonary pathology. A multi-disciplinary approach to management, involving respiratory physicians, hepatologists, and palliative care specialists is crucial to ensuring optimal patientcentered care. However, the majority of accepted therapeutic options are based on expert opinion rather than large, adequately powered randomized controlled trials. In this narrative review, we discuss the epidemiology, pathophysiology, clinical characteristics, and management of HH, highlighting the use of salt restriction and diuretic therapy, porto-systemic shunts, and liver transplantation. We include specific sections focusing on the role of pleural interventions and palliative care, respectively.

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Section: Video-assisted Thoracoscopy and Diaphragmatic Repairmentioning

confidence: 99%