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Semin Respir Crit Care Med 2001; 22(6): 665-674
DOI: 10.1055/s-2001-18803
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Hepatic Hydrothorax

José Ribas Milanez de Campos1 , Laert Oliveira Andrade Filho1 , Eduardo de Campos Werebe1 , Fernando Luiz Pandulo, Luiz Tarcísio Brito Filomeno1 , Fabio Biscegli Jatene1
  • 1Division of Thoracic Surgery, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil
  • 2Division of Hepathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Publication History

Publication Date:
05 December 2001 (online)

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ABSTRACT

Hepatic hydrothorax (HH) is an uncommon manifestation of cirrhosis with ascites. Pleural effusions form when ascitic fluid moves through diaphragmatic defects that have been opened by increased peritoneal pressure. The diagnosis is established clinically by finding a serous transudate and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces. In end-stage liver disease, the management of hepatic hydrothorax is problematic and often does not respond to medical therapy. Therapeutic options for a refractory hepatic hydrothorax include therapeutic thoracentesis, talc slurry through a chest tube, peritoneovenous and pleurovenous shunting, thoracoscopic talc poudrage, transjugular intrahepatic portosystemic shunt (TIPS), thoracosopic diaphragmatic defect repair followed by talc poudrage, and lastly, liver transplant. TIPS can be used as a bridge for transplantation but is often complicated by encephalopathy. Video assisted thoracic surgery (VATS) with patching the defect and talc poudrage may provide symptomatic relief; however, the morbidity and mortality in these extremely ill patients is high. The only definitive treatment for refractory hepatic hydrothorax associated with end-stage cirrhosis is liver transplantation.

KEYWORD

Hepatic hydrothorax - pleurodesis - thoracoscopy - pleural drainage - talc poudrage

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