Volume 6, Number 7;  July 13, 2006

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Unique Identifier [PMID]: 15287850

Authors: Gur C. Ilan Y. Shibolet O.

Institution: Liver Unit, Division of Medicine, Hadassah University Hospital, Jerusalem, Israel.

Title: Hepatic hydrothorax--pathophysiology, diagnosis and treatment--review of the literature. [Review] [40 refs]

Source: Liver International. 24(4):281-4, 2004 Aug.

Abstract: Hepatic hydrothorax is defined as the accumulation of significant pleural effusion in a cirrhotic patient without primary pulmonary or cardiac disease. Hydrothorax is uncommon occurring in up to 4-6% of all patients with cirrhosis and up to 10% in patients with decompensated cirrhosis. Although ascites is usually present, hydrothorax can occur in the absence of ascites. Patients with hepatic hydrothorax usually have advanced liver disease with portal hypertension and most of them will require liver transplantation. Over the last few years, new insights into the pathogenesis of this entity have lead to improved treatment modalities such as portosystemic shunts (TIPS) and video-assisted thoracoscopy for closure of diaphragmatic defects. These modalities may be of help as a bridge to transplantation. The aim of this review is to describe recent developments in the pathogenesis, diagnosis and treatment of hepatic hydrothorax. Copyright Blackwell Munksgaard 2004 [References: 40]

Publication Type: Journal Article. Review.

 Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 15274663

Authors: Cardenas A. Kelleher T. Chopra S.

Institution: Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. acardena@caregroup.harvard.edu

Title: Review article: hepatic hydrothorax. [Review] [54 refs]

Source: Alimentary Pharmacology & Therapeutics. 20(3):271-9, 2004 Aug 1.

Abstract: Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2-3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5-8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1-2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia. Hepatic hydrothorax is defined as a pleural effusion, usually >500 mL, in patients with cirrhosis without cardiopulmonary disease. The pathophysiology involves the direct movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. The estimated prevalence among cirrhotic patients is 5-10%. The effusion, which is a transudate, most commonly occurs in the right hemithorax. The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction and administration of diuretics. Refractory hydrothorax can be managed with transjugular intrahepatic portosystemic shunt in selected cases. Pleurodesis is not routinely recommended. Suitable patients with hepatic hydrothorax should be considered candidates for liver transplantation. [References: 54]

Publication Type: Journal Article. Review.

 Link Directly to Fulltext article in Ovid

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Unique Identifier [PMID]: 14679328

Authors: Garcia N Jr. Mihas AA.

Institution: Division of Gastroenterology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.

Title: Hepatic hydrothorax: pathophysiology, diagnosis, and management. [Review] [81 refs]

Source: Journal of Clinical Gastroenterology. 38(1):52-8, 2004 Jan.

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. [References: 81]

Publication Type: Journal Article. Review.

 Link Directly to Fulltext Article at Science Direct

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Unique Identifier [PMID]: 10492320

Authors: Lazaridis KN. Frank JW. Krowka MJ. Kamath PS.

Institution: Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.

Title: Hepatic hydrothorax: pathogenesis, diagnosis, and management. [Review] [39 refs]

Source: American Journal of Medicine. 107(3):262-7, 1999 Sep.

Abstract: Hepatic hydrothorax is defined as a pleural effusion in a patient with cirrhosis of the liver and no cardiopulmonary disease. The estimated prevalence of this often debilitating complication in patients with liver cirrhosis is 4% to 10%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. As a result patients are at increased risk of respiratory infection. Initial management consists of sodium restriction, diuretics, and thoracentesis. A transjugular intrahepatic portosystemic shunt may be required. Because most patients with hepatic hydrothorax have end-stage liver disease, a liver transplant should be considered if these options fail. [References: 39]

Publication Type: Journal Article. Review.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth