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Diagnosis and Management of Hepatic Hydrothorax
Amie Vidyani,Citra Indriani Sibarani,Budi Widodo,Herry Purbayu,Husin Thamrin,Muhammad Miftahussurur,Poernomo Boedi Setiawan,Titong Sugihartono,Ulfa Kholili,Ummi Maimunah 대한소화기학회 2024 대한소화기학회지 Vol.83 No.2
Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).
55 Years Old Women Who Visited with Difficylty in Breathing
( Byung Seok Lee ),( Duk Ki Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Introduction: Hepatic hydrothorax is a uncommon complication in patients with liver cirrhosis. Treatemnts options consist of low salt diet and diuretics dose adjutment, repetitive thoracentesis, chest catheter insertion with pleurodesis, surgical repair of diaphragmatic hernia, and Liver transplantation. Case: In 2016, June, 55 years old female came to hepatology outpatient clinic complaining of dyspnea. She was known HCV related liver cirrhosis patient on DAA therapy from April, 2016. Chest pa revealed rt. hepatic hydrothorax. We tried to control effusion by general treatemnt option (Diruetics, Catheter insertion and pleurodesis), but failed to control the effusion. So she was discharged with keeping chest cathter drainage, reluctantly. Suprisingly, with follow up period, her hepatic hydrothorax was disappeared without additional treatment. Conclusions: Our patient’s refractory hepatic hydrothorax was improved during DAA therapy. Interestingly, there wasn’t improvement of patient’s other markers of liver function (LFT, Image, Amount of ascites etc.). May be there are potential effects of DAA therapy on liver function without previously known. And we need to investigate additional mechanism of hepatic hydrothorax.
The Outcome of Thoracentesis versus Pigtail catheter for Hepatic Hydrothorax
( Seul Ki Han ),( Seong Hee Kang ),( Moon Young Kim ),( Bon Il Park ),( Baek Gyu Jun ),( Tae Suk Kim ),( Dae Hee Choi ),( Ki Tae Suk ),( Young Don Kim ),( Gab Jin Cheon ),( Dong Joon Kim ),( Soon Koo 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Hepatic hydrothorax (HH) is a rare complication and associated with poor clinical outcome in patients with cirrhosis. Conservative management for HH includes salt restriction and administration of diuretics, often with percutaneous drainage; thoracentesis, catheter drainage, and chest tube drainage. Therapeutic thoracentesis is a simple that can provide rapid relief of symptoms though it is temporary and repeated. We aimed to evaluate the efficacy and safety the use of pigtail catheters insertion compared to intermittent thoracentesis. Methods: This multicenter retrospective study included 136 cirrhotic patients with pleural fluid from March 2012 to June 2017. Cirrhosis patients with transudate pleural effusion greater than 500ml are included, other neoplasm and cardiopulmonary disease and infectious condition were excluded. Results: There were 115 cases of pigtail catheter insertion and 25 cases of intermittent thoracentesis. The mean MELD scores of the enrolled patients were 19.71 ± 7.85 and 21.57 ±8.39, respectively (P=0.32). The median catheter dwelling time was 8 days in pigtail catheter group. Spontaneous pleurodesis was occurred in 59 cases (51%) in pigtail group. Bleeding complica tion and empyema were occurred in pigtail group. The median hospitalization period was 19 day in pigtail group and 31 day in thoracentesis group (P=0.83). The overall 1-year mortality for patients treated with pigtail catheter insertion versus thoracentesis was 40.9% (n=47) and 71.4% (n=15), respectively. There was no difference in survival rate between pigtail catheter group and thoracentesis group (P=0.19). Re-admission rate for 1 year did not differ between pigtail catheter insertion group and thoracentesis group (50.1% vs. 37%, P=0.38). Conclusions: Pigtail catheter insertion can safely obviate the need for repeated thoracentesis and may be recommended for management of hepatic hydrothorax.
이승은(Seung Eun Lee),정준(Jun Jeong),변흥열(Heung Yeal Byun),한세환(Se Hwan Han),조주영(Joo Young Cho),최동환(Dong Hwan Choi) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2
Since the introduction of the LeVeen modification of the peritoneovenous shunting(PVS) in l974, these devices have been placed in a relatively large number of patients. The most common indication has been for medically intractable ascites in the setting of chronic liver disease. The ascites pump is a tubular device for ascitic fluids which allows transfer of fluid from the peritoneal cavity to the venous system, usually via the right external jugular vein. Implantable tubular devices offer another choice to ameliorate ascites, with ascitic fluid being spontaneously and continuously infused into the circulatory system. A 34-year-old female patient with clinical and laboratory evidence of liver cirrhosis was admitted to our hospital due to dyspnea and abdominal distension. A large amount of ascites was noted on physical examination and the right hydrothorax was revealed on the chest X-ray film. In addition to conservative management of ascites, repeated thoracentesis with paracentesis and chemical pleurodesis were performed, but all of these efforts could not relieve her complaint of dyspnea. So, peritoneovenous shunt was performed to resolve the intractable hepatic hydrothorax. After the shunt operation, her complaint of dyspnea was relieved, and the frequency of repeated thoracentesis diminished. However, the patient expired about 11 weeks after tbe shunt operation, and the cause of death was hepatic encephalopathy. In our report, we present a case of peritoneovenous shunting of ascites in a patient with intractable hepatic hydrothorax. This case report suggests that peritoneovenous shunt would be benificial only in carefully selected patients. (Korean J Gastroenterol l995;27:267-272)
수술로 치유된 간성수흉증 ( Hepatic Hydrothorax )
권상옥(Sang Ok Kwon),홍인수(In Soo Hong),이동기(Dong Ki Lee),배선우(Sun Woo Bae),이성우(Sung Woo Lee),오중환(Joong Hwan Oh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4
Hepatic hydrothorax is defined as the presence, in approxirnately 6% of patients with cirrhosis, of a large pleu, al effusion in the absence of primary pulmonary or cardiac disease. Clinical ascites is almost always evident and the pleural effusion is usually right-sided. A 36-yr-old woman with clinical and labolatory evidence of hepatitis B surface antigen-positive liver cirrhosis was admitted hecause of respiraton distress. A moderate amount of ascites w noted on physical i xamination arid the right hydrothorax was re:ealed on the chest X-ray film. Diagnosis was confirmed by the intraperitoneal and intrapleural injction of radioisotope Tc-tin colloid that demonstratcd the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavity. We report on a casw of refractory hepatic hydrothroax, wiiich was succesfully treated with surgical closure of diaphragmatic defect and chemical pleurodesis.
경목정맥 간내문맥정맥 단락술(Transjugular Intrahepatic Portosystemic Shunt)로 치료되지 않은 난치성 간성 흉수 1례
박혜원,허웅,김성준,신원창,최원충,이진호 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.3
Refractory hepatic hydrothorax has been treated by conservative methods: salt and water restriction, diuretics, thoracentesis, thoracostomy, and pleurodesis. The results, however, havebeen disappointing. Recently, TIPS has emerged as a new method for refractory hepatic hydrothorax, but it may lead to fatal complications. We report a case of refractory hepatic hydrothorax that was not treated by TIPS despite of successful control of ascitest. (Korean J Hepatol 2002;8:327-330)
Hepatitis C, LC : Chemical pleurodesis for the management of symptomatic hepatic hydrothorax (초)
( Tae Wan Kim ),( Hong Joo Kim ),( Jung Ho Park ),( Dong Il Park ),( Yong Kyun Cho ),( Chong Il Sohn ),( Woo Kyu Jeon ),( Byung Ik Kim ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)