Hepatic hydrothorax: Current concepts of pathophysiology and treatment options

Kiafar, Camron; Gilani, Nooman

doi:10.1016/s1665-2681(19)31831-9

Cited by 55 publications

(31 citation statements)

References 52 publications

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“…It is defined as the presence of pleural fluid (usually greater than 500 ml) without the presence of primary cardiac or pulmonary disease 5. It is mostly right-sided (85%), combined with ascites, and due to direct passage of peritoneal fluid via diaphragmatic leaks.…”

Section: Treatment Of Hepatic Hydrothoraxmentioning

confidence: 99%

“…Two types are distinguished: a progressive, severe type 1, and a type 2 which shows a more constant renal dysfunction and is commonly associated with refractory ascites 4 . Hepatic hydrothorax is also a consequence of ascites occurring in up to 10% of these patients 5. The mostly right-sided, generally large effusion is caused by transition of fluid from the abdominal cavity into the pleural space due to a leak in the diaphragm.…”

Section: Introductionmentioning

confidence: 99%

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TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update

Rössle

Gerbes

2010

Gut

217

137

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Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading to hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt (TIPS) has been proposed as an alternative to paracentesis. TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates.

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Section: Treatment Of Hepatic Hydrothoraxmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update

Rössle

Gerbes

2010

Gut

217

137

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“…Failure of medical therapy may require transjugular intrahepatic portosystemic shunting (TIPS) or video-assisted thoracoscopic (VATS) repair of diaphragmatic defects. 10 Renal involvement and the hepatorenal syndrome (HRS)…”

Section: Hepatic Hydrothoraxmentioning

confidence: 99%

The patient with cirrhosis who presents for non-hepatic surgery

Eagar

2011

Southern African Journal of Anaesthesia and Analgesia

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“…Transjugular intrahepatic portosystemic shunt (TIPS) is an option in carefully selected patients younger than 60 years of age without hepatic encephalopathy as a bridge to liver transplantation. If TIPS is not advisable, video-assisted thoracoscopic (VATS) repair of the diaphragmatic defects (with or without pleurodesis) is an option in patients who are not transplant candidates or those awaiting organ availability [65]. Current evidence discourages use of chest tubes in managing pleural effusions secondary to hepatic hydrothorax, as the common occurrence of failure to remove the chest tube increases mortality in patients with increasing severity of liver disease [66].…”

Section: Managementmentioning

confidence: 99%