Hepatic Hydrothorax

Abstract

Hepatic hydrothorax occurs in approximately 5 to 12% of patients with cirrhosis and portal hypertension. Various therapeutic modalities ranging from dietary and pharmacologic interventions to surgical approaches are available for the management of this condition. Treatment must be individualized based on the patient's response to conservative management as well as the severity of the underlying liver disease. Hepatic hydrothorax may be complicated by spontaneous bacterial empyema, which portends a poor prognosis with a mortality rate of up to 20%. All patients with hepatic hydrothorax should be evaluated for possible liver transplantation.

A fascinating presentation of hepatic hydrothorax

“…This patient presented with multiple symptoms that are prototypical of hepatic hydrothorax secondary to decompensated liver cirrhosis, including dyspnea, hypoxia, laterality of pleural effusion (right sided in up to 65%-87% of cases) [4] , transudative nature of pleural effusion and intractable nature of the pleural effusion. Even as hepatic hydrothorax is extensively reported in literature and could be found in almost 5%-10% of all patients with cirrhosis, the peculiar and strikingly labile presentation of hepatic hydrothorax in our patient, is noteworthy.…”

“…Hepatic hydrothorax is defined as a transudative pleural effusion in cirrhotic patients without underlying pulmonary or cardiac disease and is often > 500 mL in volume [1,2] . It is seen in approximately 5%-12% of all patients with cirrhosis [1,3,4] . Accumulation of fluid within the pleural cavity has greater clinical ramifications when compared to ascites, as even lesser volumes (1-2 L) can cause significant dyspnea and hypoxia.…”

Use of a Tunnelled Pleural Catheter for the Management of Refractory Hepatic Hydrothorax: A New Therapeutic Option

“…Two currently accepted theories consist of: (1) hypoalbuminemia and decreased intravascular colloid osmotic pressure secondary to diminished protein synthesis and (2) direct passage of ascitic fluid into the pleural space through minute diaphragmatic defects. These small congenital defects tend to enlarge in patients with ascites-induced elevation of peritoneal pressure, further facilitating fluid passage into the pleural cavity [2,3,4,5]. Translocation of ascitic fluid from the peritoneal cavity to the pleural space has been demonstrated by several methods.…”

“…Moreover, scintigraphic studies showing a transfer of isotopes from the peritoneal towards the pleural cavity have also been proposed as another diagnostic measure of such defects. Lastly, videothoracoscopy has also been successfully used for identification and closure of such defects [2,3,4]. …”

“…Moreover, potential renal function impairment and the risk of electrolyte imbalance might not allow an increase in dosage. In such circumstances, more invasive therapeutic strategies should be considered [2,3,4,5]. …”