Hepatic hydrothorax

Authors A. Karagiannidis, A. Koulaouzidis, Maria Karavalaki, Chew Tan.


Hepatic hydrothorax is an infrequent complication of cirrhosis
and symptoms are mainly related to shortness of
breath, cough and chest discomfort. A number of different
pathogenetic mechanisms have been postulated for the development
of pleural effusions in cirrhotic patients. Spontaneous
infection of the pleural fluid, defined as spontaneous
bacterial empyema, is a serious complication characterized
by high mortality rate. Diagnosis is based on high
clinical suspicion and initial therapy of hepatic hydrothorax
is aimed at suppressing the production of ascites with
administration of diuretics and restriction of sodium intake.
When these fail (10% of cases) and thoracentesis is
required every 2-3 weeks, the hydrothorax is defined as refractory
and alternative more aggressive therapeutic strategies,
such as thoracoscopic repair of diaphragmatic defects
with pleural sclerosis, transjugular percutaneous intrahepatic
porto-systemic shunt placement (TIPSS) and
liver transplantation, must be considered.
Key words: Hepatic Hydrothorax, spontaneous bacterial
empyema, hepatic cirrhosis, TIPSS