1/31. Refractory hepatic hydrothorax treated with transjugular intrahepatic portosystemic shunt.A 66-year-old cirrhotic woman was referred to our hospital for evaluation of refractory pleural effusion and dyspnea. Massive right sided-pleural effusion but no ascites was detected. She had been treated with diuretics and albumin, repeated thoracenteses, and pleural drainage with an intercostal catheter, all of which had failed to relieve her symptoms. The diagnosis of hepatic hydrothorax without ascites was made by injection of technetium-99m-sulfur colloid into the peritoneal cavity. A transjugular intrahepatic portosystemic shunt was placed and successfully reduced the pleural effusion, resulting in complete relief of her symptoms. The patient has been free of symptoms for 18 months after the procedure.- - - - - - - - - - ranking = 1keywords = hydrothorax (Clic here for more details about this article) |
2/31. A successful surgical repair of the hepatic hydrothorax using pneumoperitoneum: report of a case.A successful surgical repair of a right hepatic hydrothorax in the absence of ascites is reported. A technetium-99m scintigram that was injected intraperitoneally provided evidence of a one-way flow of fluid from the peritoneal to pleural cavity. To identify any possible minute defects in the diaphragm, carbon dioxide was insufflated into the peritoneal cavity during the operation. We performed a direct suture of the defect observed on the diaphragm. The pleural effusion subsequently vanished after the operation.- - - - - - - - - - ranking = 1keywords = hydrothorax (Clic here for more details about this article) |
3/31. Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax.For many years, pleural effusions have been recognized as a complication of cirrhosis, occurring in approximately 5.5% of patients. Recent studies have confirmed that small defects in the diaphragm allow for passage of ascitic fluid into the pleural space. Successful management of these patients is challenging, as many of the treatment options can be associated with increased morbidity. The initial treatment should focus on eliminating and preventing the recurrence of ascites with diuretics and water and salt restriction. For those patients who do not respond medically, more invasive techniques have been used including serial thoracentesis, chest tube placement, chemical pleurodesis, and peritoneovenous shunts. We present a patient with recurrent pleural effusions secondary to hepatic cirrhosis who was unsuccessfully treated medically, and subsequently treated with thoracentesis, chest tube drainage and pleurodesis, with ultimate resolution after transjugular intrahepatic portosystemic shunt placement.- - - - - - - - - - ranking = 0.8keywords = hydrothorax (Clic here for more details about this article) |
4/31. Spontaneous bacterial empyema caused by aeromonas veronii biotype sobria.Spontaneous bacterial empyema is a complication of hepatic hydrothorax in cirrhotic patients. The pathogen, clinical course and treatment strategy are different to the empyema secondary to pneumonia. A 54-year-old man, who was a cirrhotic patient with hepatic hydrothorax, was admitted to National taiwan University Hospital for fever, dyspnea and right side pleuritic pain. The image study revealed massive right pleural effusion and no evidence of pneumonia. The culture of pleural effusion yielded aeromonas veronii biotype sobria. The diagnosis of spontaneous bacterial empyema caused by aeromonas veronii biotype sobria was established. To our best knowledge, aeromonas veronii biotype sobria had never been reported in English literature as the causative pathogen of spontaneous bacterial empyema.- - - - - - - - - - ranking = 0.4keywords = hydrothorax (Clic here for more details about this article) |
5/31. Resolution of refractory hepatic hydrothorax after chemical pleurodesis with minocycline.Management of refractory hepatic hydrothorax is a challenge to physicians in clinical practice. We reported two patients with hepatic hydrothorax, non-alcoholic cirrhosis and rapidly recurring pleural effusion. They failed to improve with diuretics and repeated thoracentesis. Refractory hepatic hydrothorax was successfully treated by minocycline-induced pleural symphysis. After pleurodesis, ventilatory function returned to normal in both patients. No recurrence of pleural effusion was noted. We suggest that minocycline pleurodesis is an alternative treatment for refractory hepatic hydrothorax because it is simple, safe and effective.- - - - - - - - - - ranking = 1.6keywords = hydrothorax (Clic here for more details about this article) |
6/31. Treatment of hepatic hydrothorax and reduction of chest tube output with octreotide.Hepatic hydrothorax is a dreaded complication in patients with liver cirrhosis. Placement of chest tubes can alleviate respiratory distress, but patients often succumb due to excessive fluid and protein loss via the open drain. Our case illustrates that high-dose octreotide can strongly reduce hepatic hydrothorax drainage volume. This allows removal of the chest tube, which would otherwise not have been possible.- - - - - - - - - - ranking = 1.2keywords = hydrothorax (Clic here for more details about this article) |
7/31. Hepatic hydrothorax: a retrospective case study.PURPOSE: To present the pathophysiology, differential diagnoses, assessment techniques, and treatment options for hepatic hydrothorax. DATA SOURCES: A case study is presented with supporting material from current medical literature. CONCLUSIONS: Hepatic hydrothorax is a pleural effusion caused by the flow of ascitic fluid into the pleural space through an actual defect in the diaphragm. Successful outcomes depend on early detection and timely referral of often-subtle lung involvement. IMPLICATIONS FOR PRACTICE: Although incidence is reported to be as high as 12% in cirrhotic patients, standard medical references attach little importance to pulmonary risks in this population. Hepatic hydrothorax should always be considered in the cirrhotic patient with a pleural effusion.- - - - - - - - - - ranking = 1.4keywords = hydrothorax (Clic here for more details about this article) |
8/31. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis.Cryptogenic cirrhosis is a common cause of liver-related morbidity and mortality in the united states. Nonalcoholic fatty liver disease (NAFLD) is now recognized as the most common cause of cryptogenic cirrhosis. However, the diagnosis of cirrhosis in patients with NAFLD appears to be delayed compared with those with other chronic liver diseases and thus carries a higher mortality rate. This delay in diagnosis is illustrated in our case of a 53-year-old man who presented with hepatic hydrothorax and ascites, whose workup revealed cirrhosis due to NAFLD. Although a diagnosis of presumed NAFLD can be made noninvasively, a definitive diagnosis requires a liver biopsy specimen. A biopsy specimen is also important for detecting histologically advanced disease, which may be clinically silent and undetected by aminotransferases or diagnostic imaging. Although there are no proven treatments, recommendations for patients with NAFLD include avoidance of hepatotoxins and aggressive management of associated conditions, such as hypertriglyceridemia and type 2 diabetes mellitus.- - - - - - - - - - ranking = 0.2keywords = hydrothorax (Clic here for more details about this article) |
9/31. hydrothorax without ascites in liver cirrhosis.pleural effusion in patients with liver cirrhosis and intractable ascites is well known, but hepatic hydrothorax in the absence of ascites is a rare complication. We present the case of a 43-year old male, with a medical history of liver cirrhosis due to hepatitis c virus, who was admitted to the Pneumology Clinic for dyspnoea, worsening of general status and chronic asthenia. The pleural effusion, revealed on physical and laboratory examinations, persisted despite the therapy with diuretics and the frequent thoracocentesis. The thoracostomy followed by pleurodesis also failed. The pecularity of this case was the presence of refractory hydrothorax in the absence of ascites.- - - - - - - - - - ranking = 0.4keywords = hydrothorax (Clic here for more details about this article) |
10/31. Large diaphragmatic defect as the cause of hydrothorax in a cirrhotic patient: demonstration with peritoneal scintigraphy and magnetic resonance imaging.A 52-year-old man with history of post-hepatitic cirrhosis presented with ascitis and respiratory distress. Chest X-ray on admission showed a large right hydrothorax. Thoracentesis yielded a large volume of a clear transudate fluid. Peritoneal scintigraphy showed rapid migration of radiotracer into the right pleural cavity, confirming the abdominal origin of the pleural fluid and suspecting a large diaphragmatic defect. MR imaging study using ultrafast sequences confirmed the large diaphragmatic defect.- - - - - - - - - - ranking = 1keywords = hydrothorax (Clic here for more details about this article) |
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