Evidence-Based Review of the Management of Hepatic Hydrothorax

Singh, Amita; Bajwa, Abubakr; Shujaat, Adil

doi:10.1159/000346996

Cited by 78 publications

(104 citation statements)

References 88 publications

(137 reference statements)

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“…[6] Herniation of the peritoneum into the pleural space also known as pleuroperitoneal blebs can develop because of the increase in gaps between the muscle fibers of the diaphragm with increased intra-abdominal pressure. [4] This theory is further supported by the fact that air, dyes, or radiolabeled substances intra-abdominally injected in patients with hepatic hydrothorax move rapidly into the pleural cavity. [7] The diaphragmatic defects resulting in hepatic hydrothorax are classified into four morphological types [8]:…”

Section: Discussionmentioning

confidence: 96%

“…These include the transfer of the peritoneal fluid into the pleural space via diaphragmatic defects, hypoalbuminemia resulting in decreased colloid osmotic pressure and lymphatic leakage from the thoracic duct. [4] The most common explainable mechanism is the passage of ascites from the peritoneal to the pleural cavity through diaphragmatic defects. These are typically less than 1 cm and may be microscopic and are generally located in the tendinous portion of the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

“…In carefully selected patients with MELD (Model for End stage Liver disease) score <15, CTP (Child-Turcotte-Pugh) A or B and age<60 years, transjugular intrahepatic portosystemic shunt (TIPSS) can be an effective treatment of refractory hydrothorax and can be used as a bridge to liver transplantation. [4] Chemical pleurodesis via tube thoracostomy is commonly used to treat patients with recurrent malignant based pleural effusions. Experience suggests that hepatic hydrothorax is the most difficult type of nonmalignant based pleural effusion to treat with chemical pleurodesis.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Hepatic Hydrothorax in a Patient with Alcohol induced Liver Cirrhosis

Kasinathan¹,

Pillai²

2017

AJMCR

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Hepatic hydrothorax is defined as significant pleural effusion greater than 500 ml in a patient with liver cirrhosis without any underlying pulmonary, cardiac and pleural disease. This case report describes a 47 year old Indian gentleman who was diagnosed as alcohol induced liver cirrhosis, Child-Turcotte-Pugh score B, with gross ascites. He presented with recurrent right sided pleural effusion. Pleural fluid analysis revealed transudative pleural effusion. A diagnosis of hepatic hydrothorax was made after excluding other causes of pleural effusion. He did not respond to medical therapy and sodium restriction. His recurrent pleural effusion was treated with tube thoracostomy and chemical talc pleurodesis. He was referred to the tertiary hepatology unit for transjugular intrahepatic portosystemic shunt (TIPSS) and liver transplantation. Hepatic hydrothorax should always be suspected in a patient who presents with liver cirrhosis with portal hypertension and transudative pleural effusion.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Hepatic Hydrothorax in a Patient with Alcohol induced Liver Cirrhosis

Kasinathan¹,

Pillai²

2017

AJMCR

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“…Cirrhosis: effusion associated with clinical, biochemical and radiological evidence of hepatic dysfunction [13]…”

Section: Methodsmentioning

confidence: 99%

Simplified Criteria Using Pleural Fluid Cholesterol and Lactate Dehydrogenase to Distinguish between Exudative and Transudative Pleural Effusions

et al. 2019

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Background: An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. Objectives: The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. Methods: An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. Results: Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94–99]) and negative likelihood ratio (0.04 [95% CI 0.02–0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light’s criteria. Findings were similar in the validation cohort. Conclusions: Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light’s criteria. It avoids simultaneous blood sampling, thus reducing patient discomfort and potential costs.

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“…The first step in the management is sodium restriction and diuretic therapy [6]. Approximately 21-26% of these patients suffer from refractory HH and repeat thoracentesis is required for symptom control, particularly when patients are not proper candidates for transjugular intrahepatic portosystemic shunt (TIPS), liver transplant, or are awaiting transplant [7].…”

Section: Introductionmentioning

confidence: 99%

Repeat Thoracentesis in Hepatic Hydrothorax and Non-Hepatic Hydrothorax Effusions: A Case-Control Study

et al. 2018

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Background: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. Objectives: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. Methods: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. Results: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5–14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03–1.36, p = 0.012). Conclusions: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.

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Evidence-Based Review of the Management of Hepatic Hydrothorax

Cited by 78 publications

References 88 publications

A Rare Presentation of Hepatic Hydrothorax in a Patient with Alcohol induced Liver Cirrhosis

A Rare Presentation of Hepatic Hydrothorax in a Patient with Alcohol induced Liver Cirrhosis

Simplified Criteria Using Pleural Fluid Cholesterol and Lactate Dehydrogenase to Distinguish between Exudative and Transudative Pleural Effusions

Repeat Thoracentesis in Hepatic Hydrothorax and Non-Hepatic Hydrothorax Effusions: A Case-Control Study

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