316 results on '"hepatic hydrothorax"'
Search Results
2. Progression of portal hypertension after atezolizumab plus bevacizumab for hepatocellular carcinoma-report a case and literature review
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Tung-Yen Lin and Tung-Hung Su
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Liver cancer ,Immunotherapy ,VEGF ,Varices ,Ascites ,Hepatic hydrothorax ,Medicine (General) ,R5-920 - Abstract
Background: Atezolizumab/bevacizumab combination therapy became the first-line therapy for advanced hepatocellular carcinoma (HCC). Gastroesophageal varices should be monitored and managed before treatment. The progression of portal hypertension during bevacizumab-containing therapy is unclear. Method: A case of new development of esophageal varices, ascites, and hepatic hydrothorax during atezolizumab/bevacizumab therapy at National Taiwan University Hospital was reported, and relevant literature was reviewed. Results: We presented an 83-year-old male with resolved hepatitis B without cirrhosis. He had BCLC stage C HCC and received tri-weekly atezolizumab/bevacizumab therapy for 34 cycles with sustained partial response. Progressive ascites, esophageal varices, and hepatic hydrothorax developed, though his portal vein was patent and the tumor was under control. Five similar cases of HCC (BCLC B/C: n = 3/2) had been reported previously. Among them, three had cirrhosis with pre-existing small esophageal varices before treatment. After the administration of 1–15 cycles of atezolizumab/bevacizumab therapy, one patient had a progression of varices, and the other four developed variceal bleeding.The association between atezolizumab/bevacizumab and portal hypertension was possible, which might relate to the VEGF pathway and immune-related adverse events with progressive hepatic fibrosis. Conclusion: Atezolizumab/bevacizumab treatment might exacerbate portal hypertension. Careful monitoring and management should be considered during treatment.
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- 2024
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3. Outcome of Transjugular Intrahepatic Portosystemic Shunt in Patients with Cirrhosis and Refractory Hepatic Hydrothorax: A Systematic Review and Meta-analysis.
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Giri, Suprabhat, Patel, Ranjan Kumar, Tripathy, Taraprasad, Chaudhary, Mansi, Anirvan, Prajna, Chauhan, Swati, Rath, Mitali Madhumita, and Panigrahi, Manas Kumar
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MEDICAL information storage & retrieval systems ,CIRRHOSIS of the liver ,COMPLICATIONS of prosthesis ,SEVERITY of illness index ,TREATMENT effectiveness ,META-analysis ,DESCRIPTIVE statistics ,SYSTEMATIC reviews ,MEDLINE ,HEPATIC encephalopathy ,PLEURA diseases ,SURGICAL arteriovenous shunts ,CONFIDENCE intervals ,ADVERSE health care events ,LIVER failure ,DISEASE incidence ,EVALUATION ,DISEASE complications - Abstract
Background Around 5% of patients with cirrhosis of the liver develop hepatic hydrothorax (HH). For patients with refractory HH (RHH), transjugular intrahepatic portosystemic shunt (TIPS) has been investigated in small studies. Hence, the present meta-analysis aimed to summarize the current data on the outcome of TIPS in patients with RHH. Methods From inception through June 2023, MEDLINE, Embase, and Scopus were searched for studies analyzing the outcome of TIPS in RHH. Clinical response, adverse events (AEs), mortality, and shunt dysfunction were the primary outcomes assessed. The event rates with their 95% confidence interval were calculated using a random-effects model. Results A total of 12 studies (n = 466) were included in the final analysis. The pooled complete and partial response rates were 47.2% (35.8–58.5%) and 25.5% (16.7–34.3%), respectively. The pooled incidences of serious AEs and post-TIPS liver failure after TIPS in RHH were 5.6% (2.1–9.0%) and 7.6% (3.1–12.1%), respectively. The pooled incidences of overall hepatic encephalopathy (HE) and severe HE nonresponsive to standard treatment after TIPS in RHH were 33.2% (20.0–46.4%) and 3.6% (0.4–6.8%), respectively. The pooled 1-month and 1-year mortality rates were 14.0% (8.3–19.6%) and 42.0% (33.5–50.4%), respectively. The pooled incidence of shunt dysfunction after TIPS in RHH was 24.2% (16.3–32.2%). Conclusion RHH has a modest response to TIPS in patients with cirrhosis, with only half having a complete response. Further studies are required to ascertain whether early TIPS can improve the outcome of patients with cirrhosis and HH. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Pulmonary Complications of the Liver.
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Sabate, Constanza Delfina, Camere, Maurizio, Heeren, Carmen, and Mendizabal, Manuel
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Purpose of Review: Hepatic hydrothorax (HH), hepatopulmonary syndrome (HPS), and portopulmonary hypertension (PoPH) are the most common complications of portal hypertension. In this review we will discuss the most relevant aspects regarding its diagnosis and treatment. Recent Findings: Pulmonary complications of the liver are associated with a detrimental quality of life and decreased survival. HH can be reported in up to 15% of patients with cirrhosis and it is usually associated with ascites. HPS and PoPH are severe pulmonary vascular complications of portal hypertension and they are not associated with neither the severity of portal hypertension nor the etiology of liver disease. Patients with prompt screening of these complications can benefit with timely treatment and eventually, liver transplantation. Summary: Liver transplantation is the ultimate treatment to resolve HH, HPS, and PoPH. However, the post-transplant course of PoPH can be challenging and patients might still require indefinitely vasomodulatory therapies. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Progression of portal hypertension after atezolizumab plus bevacizumab for hepatocellular carcinoma-report a case and literature review.
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Lin, Tung-Yen and Su, Tung-Hung
- Subjects
DRUG side effects ,PORTAL hypertension ,LITERATURE reviews ,HEPATIC fibrosis ,PORTAL vein - Abstract
Atezolizumab/bevacizumab combination therapy became the first-line therapy for advanced hepatocellular carcinoma (HCC). Gastroesophageal varices should be monitored and managed before treatment. The progression of portal hypertension during bevacizumab-containing therapy is unclear. A case of new development of esophageal varices, ascites, and hepatic hydrothorax during atezolizumab/bevacizumab therapy at National Taiwan University Hospital was reported, and relevant literature was reviewed. We presented an 83-year-old male with resolved hepatitis B without cirrhosis. He had BCLC stage C HCC and received tri-weekly atezolizumab/bevacizumab therapy for 34 cycles with sustained partial response. Progressive ascites, esophageal varices, and hepatic hydrothorax developed, though his portal vein was patent and the tumor was under control. Five similar cases of HCC (BCLC B/C: n = 3/2) had been reported previously. Among them, three had cirrhosis with pre-existing small esophageal varices before treatment. After the administration of 1–15 cycles of atezolizumab/bevacizumab therapy, one patient had a progression of varices, and the other four developed variceal bleeding. The association between atezolizumab/bevacizumab and portal hypertension was possible, which might relate to the VEGF pathway and immune-related adverse events with progressive hepatic fibrosis. Atezolizumab/bevacizumab treatment might exacerbate portal hypertension. Careful monitoring and management should be considered during treatment. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
6. Pulmonary complications of advanced chronic liver diseases: an updated review
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Thierry Thevenot, Sarah Raevens, Avinash Aujayeb, Bubu A. Banini, Jean François D. Cadranel, and Hilary M. DuBrock
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portopulmonary hypertension ,hepatopulmonary syndrome ,hepatic hydrothorax ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Patients with advanced chronic liver disease can develop specific pulmonary complications related or unrelated to pre-existing lung disease. The three major pulmonary complications in this patient population include hepatopulmonary syndrome (HPS), portopulmonary hypertension (PoPH), and hepatic hydrothorax (HH). These entities are most often revealed by increasing dyspnea together with signs of portal hypertension. The prevalence of these complications remains underestimated due to the lack of routine screening of the cirrhotic population. The pathophysiology of HH is better understood than that of HPS and PoPH. The clinical features, diagnosis, and therapeutic options of these pulmonary complications are extensively discussed in this chapter. Liver transplantation may offer a curative therapy in highly-selected cases and MELD exception points allow priority access to liver transplantation, thus avoiding potential deterioration while awaiting transplant and providing a better post liver transplant survival. The complexity of managing these pulmonary complications requires a multidisciplinary team approach, especially when liver transplantation is indicated.
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- 2024
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7. Diagnosis and Management of Hepatic Hydrothorax
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Amie Vidyani, Citra Indriani Sibarani, Budi Widodo, Herry Purbayu, Husin Thamrin, Muhammad Miftahussurur, Poernomo Boedi Setiawan, Titong Sugihartono, Ulfa Kholili, and Ummi Maimunah
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complication ,diagnoses ,hepatic hydrothorax ,manifestation ,treatment ,Medicine - Abstract
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).
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- 2024
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8. TIPS for Refractory Ascites and Hepatic Hydrothorax.
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Rajan, Anjana and Boike, Justin
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Purpose of Review: This review summarizes the pathophysiology of portal hypertension, outcome data through the years supporting the use of TIPS in refractory ascites (RA) and hepatic hydrothorax (HH), and considerations for ideal TIPS candidates. Recent Findings: Advances in stent technology over the last three decades have dramatically improved both quality of life and survival for patients with RA and HH. Importantly, the advent of controlled-expansion, covered stents has reduced the incidence of post-TIPS hepatic encephalopathy (HE) and mortality rates. Summary: Controlled-expansion covered stents are now the guideline-recommended device for patients undergoing TIPS. Prospective trials including these newer TIPS recipients are still needed to determine ideal stent diameter, effective intra-operative portosystemic gradient cutoffs, and utility of pharmacologic HE prophylaxis for the indications of RA and/or HH. [ABSTRACT FROM AUTHOR]
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- 2024
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9. A case of refractory hepatic hydrothorax due to pleuroperitoneal communication successfully controlled by diaphragmatic plication and subsequent peritoneovenous shunting.
- Author
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Nagai, Arisa, Sugimoto, Kazushi, Yamamoto, Takayuki, Wakabayashi, Hideki, Kaneda, Shinji, Nakagawa, Naoki, and Yamamoto, Norihiko
- Abstract
In general, control of hepatic hydrothorax is difficult, and patients have a poor prognosis. A case in which hepatic hydrothorax was well controlled for a long time after diaphragm plication and subsequent Denver shunt placement is reported. A 70-year-old man with decompensated liver cirrhosis presented with progressive exertional dyspnea. 5 years before admission, hepatic ascites associated with portal hypertension appeared, and a left pleural effusion subsequently developed. The pleural effusion was not controlled by salt restriction and diuretics. Based on the clinical findings, the existence of pleuroperitoneal communication was strongly suspected, and surgical diaphragmatic plication was performed. After the treatment, the pleural effusion did not accumulate, but ascites increased significantly, and conservative therapy was ineffective. For the treatment of massive ascites, a peritoneovenous shunt (Denver shunt®) was placed. Although more than 2 years have passed, the thoracoabdominal effusions have not accumulated, and the patient has been asymptomatic. The present case suggests that multidisciplinary treatment may improve the prognosis of patients with refractory thoracoabdominal effusions. [ABSTRACT FROM AUTHOR]
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- 2024
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10. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations
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Jean-François David Cadranel, Isabelle Ollivier-Hourmand, Jacques Cadranel, Thierry Thevenot, Honoré Zougmore, Eric Nguyen-Khac, Christophe Bureau, Manon Allaire, Jean-Baptiste Nousbaum, Véronique Loustaud-Ratti, Xavier Causse, Philippe Sogni, Bertrand Hanslik, Marc Bourliere, Jean-Marie Peron, Nathalie Ganne-Carrie, Thong Dao, Dominique Thabut, Bernard. Maitre, Nabil Debzi, Ryad Smadhi, Roger Sombie, Raimi Kpossou, Olivier Nouel, Julien Bissonnette, Isaac Ruiz, Mourad Medmoun, Sergio Negrin Dastis, Pierre Deltenre, Florent Artru, Chantal Raherison, Laure Elkrief, and Tristan Lemagoarou
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Hepatic hydrothorax ,Therapeutic pleural puncture ,Albumin infusion ,Spontaneous bacterial empyema ,Talcage pleurodesis ,Indwelling pleural catheter ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. Methods Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. Results Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p
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- 2023
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11. A study to assess the prevalence of pulmonary complications in patients of chronic liver disease.
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Chandel, Kuldeep, Jain, Rajat, Siddiqui, Zaki, Kumar, Hitesh, Singh, Medha, and Kumar, Mithilesh
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CHRONICALLY ill , *PATIENT portals , *PULSE oximetry , *PORTAL hypertension , *PULSE oximeters , *LIVER transplantation - Abstract
Background: Patients with cirrhosis and portal hypertension have been associated with pulmonary complications e.g.; dyspnoea, haemoptysis, cor pulmonale etc. These can be a spectrum of major pulmonary complications affecting CLD found in various studies (incidence - 40% in patients planned for Liver Transplant). Aim of the study: To find the Prevalence and Clinical spectrum of pulmonary complications in CLD patients. Material and Methods: Observational cross-sectional, prospective study with purposive sampling (100 samples) in Medicine Department, M.L.B. Medical College, Jhansi from Dec 2020-October 2022. Results: Maximum patients were below 55 years of age (57%) with Alcohol as the commonest aetiology (58%) and personal history (78%). HPS (33%) is the commonest pulmonary complication followed by HH (30%), PH (18%) and POPH (9%) CLD with Child-Pugh Class C had maximum complications (59%), followed by Class B (26%) and Class A (15%). SP02/Pa02 categorized HPS into Mild-HPS (42.4%), Moderate-HPS (18.2%), Severe-HPS (30.3%) & Very Severe-HPS (9.1%). ECG/TTE categorized PH/POPH into High-grade (59.3%), Intermediate-grade (22.2%) and Mild-grade pulmonaryhypertension (18.5%). Conclusion: The major pulmonary complications of CLD includes HPS, HH, PH and POPH. Pulse oximetry is a simple and non-invasive method used for detecting and grading HPS severity. Imaging studies viz; CXR/HRCT-Thorax/ECG/Trans-Thoracic-Echocardiography facilitate in identifying Hepatic-Hydrothorax, Pulmonary-Hypertension and Portopulmonary-Hypertension which complicates CLD. Since this is a Hospital-based study with purposive-sampling, therefore further studies need to be carried out to corroborate or defy the study results. [ABSTRACT FROM AUTHOR]
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- 2023
12. Medical thoracoscopy with talc pleurodesis for refractory hepatic hydrothorax: A case series of three successes
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Y. Rahim, R.V. Reddy, M. Naeem, and G. Tsaknis
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Pleural effusion ,Hepatic hydrothorax ,Medical thoracoscopy ,Talc pleurodesis ,Diseases of the respiratory system ,RC705-779 - Abstract
Medical thoracoscopy with chemical pleurodesis is a last resort for managing patients who suffer.from recurrent hepatic hydrothorax. However, despite pleurodesis, the rapid fluid build-up can hinder the successful apposition of the pleural surfaces. To improve the chances of success, we investigated the effectiveness of abdominal paracentesis before chemical pleurodesis via medical thoracoscopy to reduce significant fluid shifts from the peritoneal to the pleural cavity.We present a series of three patients with liver cirrhosis complicated by hepatic hydrothorax who underwent medical thoracoscopy with talc pleurodesis. Before the procedure, we optimised medical treatment, and if needed, we performed large-volume paracentesis to prevent rapid reaccumulation of pleural fluid. All study subjects achieved treatment success, defined as relief of breathlessness and absence of pleural effusion at 12 months.Complications related to the treatment included hepatic encephalopathy and acute kidney injury, which were managed conservatively. To manage symptomatic and recurrent hepatic hydrothorax, medical thoracoscopy with talc pleurodesis, preceded by the evacuation of ascites, can be considered as a treatment option. This procedure should be considered early for those who do not respond to medical management and are not suitable candidates for TIPS or liver transplantation.
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- 2024
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13. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations.
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Cadranel, Jean-François David, Ollivier-Hourmand, Isabelle, Cadranel, Jacques, Thevenot, Thierry, Zougmore, Honoré, Nguyen-Khac, Eric, Bureau, Christophe, Allaire, Manon, Nousbaum, Jean-Baptiste, Loustaud-Ratti, Véronique, Causse, Xavier, Sogni, Philippe, Hanslik, Bertrand, Bourliere, Marc, Peron, Jean-Marie, Ganne-Carrie, Nathalie, Dao, Thong, Thabut, Dominique, Maitre, Bernard., and Debzi, Nabil
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PULMONOLOGISTS ,HYDROTHORAX ,IMPLANTABLE catheters ,PORTAL hypertension ,PLEURAL effusions - Abstract
Background: The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. Methods: Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. Results: Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p < 0.001). A chest X-ray was performed before a puncture for 73% of the respondeurs (79% hepatogastroenterologists vs 54% pulmonologists; p < 0.001). In case of a spontaneous bacterial empyema, an albumin infusion was used by 73% hepatogastroenterologists and 20% pulmonologists (p < 0.001). A drain was used by 37% of the responders (37% hepatogastroenterologists vs 31% pulmonologists; p = 0.26).An Indwelling pleural catheter was used by 50% pulmonologists and 22% hepatogastroenterologists (p < 0.01). TIPS was recommended by 78% of the responders (85% hepatogastroenterologists vs 52% pulmonologists; p < 0.001) and a liver transplantation, by 76% of the responders (86% hepatogastroenterologists vs 44% pulmonologists; p < 0.001). Conclusions: The results of this large study provide important data on practices of French speaking hepatogastroenterologists and pulmonologists; it appears that recommendations are warranted. [ABSTRACT FROM AUTHOR]
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- 2023
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14. Pulmonary Assessment of the Liver Transplant Recipient.
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Panackel, Charles, Fawaz, Mohammed, Jacob, Mathew, and Raja, Kaiser
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PULMONARY hypertension , *LIVER transplantation , *PULMONARY arterial hypertension , *PATIENT portals , *LUNG diseases , *PLEURAL effusions , *PORTAL hypertension - Abstract
Respiratory symptoms and hypoxemia can complicate chronic liver disease and portal hypertension. Various pulmonary disorders affecting the pleura, lung parenchyma, and pulmonary vasculature are seen in end-stage liver disease, complicating liver transplantation (LT). Approximately 8% of cirrhotic patients in an intensive care unit develop severe pulmonary problems. These disorders affect waiting list mortality and posttransplant outcomes. A thorough history, physical examination, and appropriate laboratory tests help diagnose and assess the severity to risk stratify pulmonary diseases before LT. Hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax (HH) are respiratory consequences specific to cirrhosis and portal hypertension. HPS is seen in 5–30% of cirrhosis cases and is characterized by impaired oxygenation due to intrapulmonary vascular dilatations and arteriovenous shunts. Severe HPS is an indication of LT. The majority of patients with HPS resolve their hypoxemia after LT. When pulmonary arterial hypertension occurs in patients with portal hypertension, it is called POPH. All other causes of pulmonary arterial hypertension should be ruled out before labeling as POPH. Since severe POPH (mean pulmonary artery pressure [mPAP] >50 mm Hg) is a relative contraindication for LT, it is crucial to screen for POPH before LT. Those with moderate POPH (mPAP >35 mm Hg), who improve with medical therapy, will benefit from LT. A transudative pleural effusion called hepatic hydrothorax (HH) is seen in 5–10% of people with cirrhosis. Refractory cases of HH benefit from LT. In recent years, increasing clinical expertise and advances in the medical field have resulted in better outcomes in patients with moderate to severe pulmonary disorders, who undergo LT. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Lung Abnormalities in Liver Cirrhosis: A Review.
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Yaman, Muli and Mustika, Syifa
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TREATMENT of cirrhosis of the liver ,ECHOCARDIOGRAPHY ,HEPATOPULMONARY syndrome ,CHEST X rays ,PULMONARY hypertension ,CIRRHOSIS of the liver ,PULSE oximetry ,THERAPEUTIC embolization ,SYMPTOMS ,OXYGEN therapy ,PLEURA diseases ,EMPYEMA ,LIVER transplantation ,DISEASE complications - Published
- 2023
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16. HEPATIC HYDROTHORAX WITHOUT ASCITES: A DIAGNOSTIC AND MANAGEMENT CHALLENGE.
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Malick, Maria, Shahid, Wajeeha, Lateef, Anum, Zubair, Zarafshan, and Zaidi, Syeda Moazzama
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TREATMENT of cirrhosis of the liver ,PLEURAL effusions ,ASCITES ,ASCITIC fluids ,DIURETICS - Abstract
Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis who does not have other reasons to have a pleural effusion (e.g., cardiac, pulmonary, or pleural disease). Hepatic hydrothorax occurs in approximately 5-6% of patients with cirrhosis. It results from the ascitic fluid draining into the pleural cavity through the diaphragmatic defects. The presentation of patients with hepatic hydrothorax includes chest pain, hypoxemia, cough, shortness of breath and fatigue. The atypical feature, in this case, is the presence of hepatic hydrothorax in a patient with chronic liver disease without ascites. The management of hepatic hydrothorax is difficult. The initial treatment should be a low-salt diet plus diuretics. The best diuretic regimen is probably the combination of furosemide and spironolactone. However, about 25% of patients are refractory to this regimen, and additional therapy is indicated. This patient underwent thoracentesis, however, considering the re-accumulation of fluid, a pigtail catheter was placed which drained up to 8 liters of fluid. [ABSTRACT FROM AUTHOR]
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- 2023
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17. Risk factors for hepatic hydrothorax in patients with cirrhosis: a clinical retrospective study
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Xue Bai, Xiaoyan Liu, Yanhui Shi, Wenwen Li, Qiang Li, and Wenjun Du
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liver cirrhosis ,hepatic hydrothorax ,risk factors ,MELD scores ,portal vein ,Medicine (General) ,R5-920 - Abstract
Aims and backgroundHepatic hydrothorax, which presents as an unexplained pleural effusion, is one of the important complications in patients with end-stage cirrhosis. It has a significant correlation with prognosis and mortality. The aim of this clinical study was to detect the risk factors for hepatic hydrothorax in patients with cirrhosis and to better understand potentially life-threatening complications.MethodsRetrospectively, 978 cirrhotic patients who were hospitalized at the Shandong Public Health Clinical Center from 2013 to 2021 were involved in this study. They were divided into the observation group and the control group based on the presence of hepatic hydrothorax. The epidemiological, clinical, laboratory, and radiological characteristics of the patients were collected and analyzed. ROC curves were used to evaluate the forecasting ability of the candidate model. Furthermore, 487 cases in the experimental group were divided into left, right, and bilateral groups, and the data were analyzed.ResultsThe patients in the observation group had a higher proportion of upper gastrointestinal bleeding (UGIB), a history of spleen surgery, and a higher model for end-stage liver disease (MELD) scores compared with the control group. The width of the portal vein (PVW) (P = 0.022), prothrombin activity (PTA) (P = 0.012), D-dimer (P = 0.010), immunoglobulin G (IgG) (P = 0.007), high-density lipoprotein cholesterol (HDL) (P = 0.022), and the MELD score were significantly associated with the occurrence of the hepatic hydrothorax. The AUC of the candidate model was 0.805 (P < 0.001, 95% CI = 0.758–0.851). Portal vein thrombosis was more common in bilateral pleural effusion compared with the left and right sides (P = 0.018).ConclusionThe occurrence of hepatic hydrothorax has a close relationship with lower HDL, PTA, and higher PVW, D-dimer, IgG, and MELD scores. Portal vein thrombosis is more common in cirrhotic patients with bilateral pleural effusion compared to those with unilateral pleural effusion.
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- 2023
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18. Liver Cirrhosis Patient with Complications of Hepatic Hydrothorax. Case Report.
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Vidyani, Amie, Sugihartono, Titong, Widodo, Budi, Purbayu, Herry, Maimunah, Ummi, kholili, Ulfa, Thamrin, Husin, Miftahussurur, Muhammad, Abbas Nussi, Iswan, and Setiawan, Poernomo Boedi
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CIRRHOSIS of the liver ,HEPATIC echinococcosis ,PATIENT experience ,ASCITES ,DYSPNEA ,HYDROTHORAX ,SURVIVAL rate ,COMPUTED tomography ,PLEURAL effusions - Abstract
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- 2023
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19. Implications of Pleural Fluid Composition in Persistent Pleural Effusion following Orthotopic Liver Transplant.
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Patel, Bhavesh H., Melamed, Kathryn H., Wilhalme, Holly, Day, Gwenyth L., Wang, Tisha, DiNorcia, Joseph, Farmer, Douglas, Agopian, Vatche, Kaldas, Fady, and Barjaktarevic, Igor
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PLEURAL effusions ,LIVER transplantation ,EXUDATES & transudates ,CELL analysis ,LACTATE dehydrogenase ,PLEURODESIS - Abstract
Persistent pleural effusions (PPEf) represent a known complication of orthotopic liver transplant (OLT). However, their clinical relevance is not well described. We evaluated the clinical, biochemical, and cellular characteristics of post-OLT PPEf and assessed their relationship with longitudinal outcomes. We performed a retrospective cohort study of OLT recipients between 2006 and 2015. Included patients had post-OLT PPEf, defined by effusion persisting >30 days after OLT and available pleural fluid analysis. PPEf were classified as transudates or exudates (Exud
Light ) by Light's criteria. Exudates were subclassified as those with elevated lactate dehydrogenase (ExudLDH ) or elevated protein (ExudProt ). Cellular composition was classified as neutrophil- or lymphocyte-predominant. Of 1602 OLT patients, 124 (7.7%) had PPEf, of which 90.2% were ExudLight . Compared to all OLT recipients, PPEf patients had lower two-year survival (HR 1.63; p = 0.002). Among PPEf patients, one-year mortality was associated with pleural fluid RBC count (p = 0.03). While ExudLight and ExudProt showed no association with outcomes, ExudLDH were associated with increased ventilator dependence (p = 0.03) and postoperative length of stay (p = 0.03). Neutrophil-predominant effusions were associated with increased postoperative ventilator dependence (p = 0.03), vasopressor dependence (p = 0.02), and surgical pleural intervention (p = 0.02). In summary, post-OLT PPEf were associated with increased mortality. Ninety percent of these effusions were exudates by Light's criteria. Defining exudates using LDH only and incorporating cellular analysis, including neutrophils and RBCs, was useful in predicting morbidity. [ABSTRACT FROM AUTHOR]- Published
- 2023
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20. Analysis of clinical features and prognostic factors in patients with hepatic hydrothorax: a single-center study from China
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Bo Ma, Tianling Shang, Jianjie Huang, Zhixin Tu, Yan Wang, Yujin Han, Xiaoyu Wen, and Qinglong Jin
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Hepatic hydrothorax ,Clinical features ,Decompensated cirrhosis ,Portal hypertension ,Prognostic factors ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background The clinical features and factors affecting the prognostic survival of hepatic hydrothorax (HH) are currently unknown. Methods We conducted a retrospective cohort study of 131 patients with HH using the Kaplan–Meier method and Cox proportional hazards regression analysis to assess factors influencing the prognosis of HH. Results A total of 131 patients were enrolled: the male to female ratio was 80:51 (1.59:1), and the mean age was 52.76 ± 11.88 years. Hepatitis B cirrhosis was the main cause of HH, and abdominal distention and dyspnea were the most common clinical signs. Ascites was present in varying amounts in all patients and was the most common decompensated complication, with pleural effusions mostly seen on the right side (107/131; 82%), followed by the left side (16/131; 12%) and bilateral effusions (8/131; 6%). For overall survival without transplantation, the estimated median survival time was 21 (95% confidence interval [CI]:18–25) months, and survival rates at 6 months, 1 year, and 2 years were 77.2%, 62.4%, and 29.7%, respectively. After controlling for covariates that were associated with liver-related mortality in the univariate analysis, males (hazard ratio [HR]: 1.721, 95% CI: 1.114–2.658, P = 0.005) and combined hepatic encephalopathy (HR: 2.016, 95% CI: 1.101–3.693, P = 0.001) were found to be associated with an increase in liver-related mortality. Conclusions In this cohort of HH patients without liver transplantation, male sex and hepatic encephalopathy were associated with a higher risk of liver-related death.
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- 2022
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21. Hepatic Chylothorax: An Uncommon Pleural Effusion.
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Akbar, Aelia, Hendrickson, Tara, Vangara, Avinash, Marlowe, Stanley, Hussain, Akbar, and Ganti, Subramanya Shyam
- Abstract
An 83-year-old male with chronic obstructive pulmonary disease and liver cirrhosis presented with confusion and dyspnea. On chest X-ray, he had the right mid to lower lung zone white out. Ultrasound-guided thoracentesis drained 1.5 L of milky white pleural fluid which was transudative according to chemical analysis. Transudative chylothorax in liver cirrhosis without ascites is rare, but can happen. When the flow of ascitic chylous fluid into the pleural space equals the rate of ascites production, clinical absence of detectable ascites will occur. Hepatic chylothorax is important and should be kept in differentials when evaluating patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Outcome of Intermittent Thoracentesis versus Pigtail Catheter Drainage for Hepatic Hydrothorax.
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Han, Seul-Ki, Kang, Seong-Hee, Kim, Moon-Young, Na, Seong-Kyun, Kim, Taehyung, Lee, Minjong, Jun, Baek-Gyu, Kim, Tae-Suk, Choi, Dae-Hee, Suk, Ki-Tae, Kim, Young-Don, Cheon, Gab-Jin, Yim, Hyung-Joon, Kim, Dong-Joon, and Baik, Soon-Koo
- Subjects
- *
CHEST paracentesis , *HYDROTHORAX , *CATHETERS , *EXOTROPIA , *PLEURAL effusions , *OVERALL survival - Abstract
Background/Aims: The management of hepatic hydrothorax (HH) remains a challenging clinical scenario with suboptimal options. We investigated the effect and safety of pigtail catheter drainage compared to intermittent thoracentesis. Methods: This multicenter, retrospective study included 164 cirrhotic patients with recurrent pleural effusion from March 2012 to June 2017. Patients with neoplasms, cardiopulmonary disease, and infectious conditions were excluded. We compared the clinical outcomes of pigtail catheter drainage versus thoracentesis for variables including complications related to procedures, overall survival, and re-admission rates. Results: A total of 164 patients were divided into pigtail catheter (n = 115) and thoracentesis (n = 49) groups. During the follow-up period of 6.93 months after discharge, 98 patients died (pigtail; n = 47 vs. thoracentesis; n = 51). The overall survival (p = 0.61) and 30-day mortality (p = 0.77) rates were similar between the pigtail catheter and thoracentesis groups. Only MELD scores were associated with overall survival (adjusted HR, 1.08; p < 0.01) in patients with HH. Spontaneous pleurodesis occurred in 59 patients (51.3%) in the pigtail catheter group. Re-admission rates did not differ between the pigtail catheter and thoracentesis groups (13.2% vs 19.6% p = 0.7). A total of five complications occurred, including four total cases of bleeding (one patient in the pigtail catheter group and three in the thoracentesis group) and one case of empyema in the pigtail catheter group. Conclusions: Pigtail catheter drainage is not inferior to that of intermittent thoracentesis for the management of HH, proving it may be an effective and safe clinical option. [ABSTRACT FROM AUTHOR]
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- 2022
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23. Refractory Hepatic Hydrothorax Is an Independent Predictor of Mortality When Compared to Refractory Ascites.
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Osman, Karim T., Abdelfattah, Ahmed M., Mahmood, Syed K., Elkhabiry, Lina, Gordon, Fredric D., and Qamar, Amir A.
- Abstract
Background: Hepatic hydrothorax (HHT) is an uncommon but significant complication of cirrhosis and portal hypertension, associated with a worse prognosis and mortality. Nearly 25% of patients with HHT will have refractory pleural effusion. It is unclear if refractory HHT has a different prognosis compared to refractory ascites. Aims: We aim to evaluate the prognostic significance of refractory HHT when compared to refractory ascites. Methods: Forty-seven patients who had refractory HHT in a tertiary care center were identified, and matched, retrospectively, one-to-one by age, gender and MELD-Na with 47 patients with refractory ascites. One-year mortality rate was compared between both groups. Cox proportional hazard regression was used to identify the association between different covariates and primary endpoint. Results: The 1-year mortality was 51.06% in the HHT group compared to 19.15% in the refractory ascites group. The median survival for patients with refractory hepatic hydrothorax was 4.87 months while the median survival for patients with refractory ascites exceeded 1 year. The presence of HHT was statistically significant in predicting the development of 1-year mortality [Hazard Ratio (HR) 4.45, 95% Confidence Interval (CI) 2.25–8.82; P value < 0.001]. Furthermore, refractory HHT remained associated with one-year mortality after adjusting for all other covariates. In a subgroup of patients with MELD-Na ≤ 20, HHT continued to be a significant predictor of one-year mortality (HR 3.30, 95% CI 1.47–7.40; P value 0.004). Conclusions: Refractory HHT is a significant independent predictor of mortality and offers additional prognostic value. [ABSTRACT FROM AUTHOR]
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- 2022
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24. Hepatic Hydrothorax: A Narrative Review.
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Pippard, Benjamin, Bhatnagar, Malvika, McNeill, Lisa, Donnelly, Mhairi, Frew, Katie, and Aujayeb, Avinash
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- *
HYDROTHORAX , *PLEURAL effusions , *OVERALL survival , *PHYSICIANS , *PALLIATIVE treatment , *RANDOMIZED controlled trials - Abstract
Hepatic hydrothorax (HH) represents a distinct clinical entity within the broader classification of pleural effusion that is associated with significant morbidity and mortality. The median survival of patients with cirrhosis who develop HH is 8–12 months. The diagnosis is typically made in the context of advanced liver disease and ascites, in the absence of underlying cardio-pulmonary pathology. A multi-disciplinary approach to management, involving respiratory physicians, hepatologists, and palliative care specialists is crucial to ensuring optimal patient-centered care. However, the majority of accepted therapeutic options are based on expert opinion rather than large, adequately powered randomized controlled trials. In this narrative review, we discuss the epidemiology, pathophysiology, clinical characteristics, and management of HH, highlighting the use of salt restriction and diuretic therapy, porto-systemic shunts, and liver transplantation. We include specific sections focusing on the role of pleural interventions and palliative care, respectively. [ABSTRACT FROM AUTHOR]
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- 2022
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25. Nonmalignant Pleural Effusions.
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Porcel, José M
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Although the potential causes of nonmalignant pleural effusions are many, the management of a few, including complicated pleural infections and refractory heart failure and hepatic hydrothoraces, can be challenging and requires the assistance of interventional pulmonologists. A pragmatic approach to complicated parapneumonic effusions or empyemas is the insertion of a small-bore chest tube (e.g., 14-16 Fr) through which fibrinolytics (e.g., urokinase and alteplase) and DNase are administered in combination. Therapeutic thoracenteses are usually reserved for small to moderate effusions that are expected to be completely aspirated at a single time, whereas video-assisted thoracic surgery should be considered after failure of intrapleural enzyme therapy. Refractory cardiac and liver-induced pleural effusions portend a poor prognosis. In cases of heart failure-related effusions, therapeutic thoracentesis is the first-line palliative therapy. However, if it is frequently needed, an indwelling pleural catheter (IPC) is recommended. In patients with hepatic hydrothorax, repeated therapeutic thoracenteses are commonly performed while a multidisciplinary decision on the most appropriate definitive management is taken. The percutaneous creation of a portosystemic shunt may be used as a bridge to liver transplantation or as a potential definitive therapy in nontransplant candidates. In general, an IPC should be avoided because of the high risk of complications, particularly infections, that may jeopardize candidacy for liver transplantation. Even so, in noncandidates for liver transplant or surgical correction of diaphragmatic defects, IPC is a therapeutic option as valid as serial thoracenteses. [ABSTRACT FROM AUTHOR]
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- 2022
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26. Early thoracentesis correlated with survival benefit in patients with spontaneous bacterial empyema.
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Albitar, Hasan Ahmad Hasan, Iyer, Vivek, Nelson, Darlene R., Kern, Ryan M., Leise, Michael, and Gallo De Moraes, Alice
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Spontaneous bacterial empyema (SBEM) is a rare complication of hepatic hydrothorax characterized by hydrothorax infection in the absence of pneumonia. We conducted this study to compare clinical outcomes in SBEM patients who underwent early thoracentesis (ET) (≤ 24 h from presentation) versus those who underwent delayed thoracentesis (DT). All patients diagnosed with SBEM at Mayo Clinic Rochester, Minnesota from January 1st 1999 to December 31st 2020 were reviewed. Demographics, pleural fluid studies, laboratory results and clinical outcomes were analyzed. A total of 54 SBEM patients (27 ET and 27 DT) were identified with 38 (70.4%) of patients presenting with right-sided effusions. Both groups had similar baseline characteristics. The rate of ICU admission was significantly higher in the DT group (15 (55.6%) vs. 7 (25.9%) patients, P = 0.027). Patients with DT had similar rate of AKI (11 (40.7%) vs. 6 (22.2%) patients, P = 0.074). In-hospital mortality (11 (40.7%) vs. 2 (7.4%) patients, P = 0.004), 3-month mortality (16 (59.3%) vs. 2 (7.4%) patients, P < 0.001) and 1-year mortality rate (21 (77.8%) vs. 6 (22.2%) patients, P < 0.001) were higher in the DT group. Patients with SBEM who underwent thoracentesis after 24 h from presentation (DT) had higher rates of mortality and ICU admission compared to patients who received early thoracentesis. Thoracentesis should be performed early in patients with suspected SBEM since it may improve survival. [ABSTRACT FROM AUTHOR]
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- 2022
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27. Intractable Hepatic Hydrothorax: A Successful Outcome following CPAP Treatment
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Hassene Attout, Khalil Samaan, Hichem Bouhamla, Sofia Amichi, and Kamel Dahmani
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cirrhosis ,hepatic hydrothorax ,cpap ,Medicine - Abstract
Hepatic hydrothorax is an uncommon complication in patients with end-stage liver disease. It may result in dyspnoea, hypoxia and infection, and carries a poor prognosis. Initial treatment is based on a sodium-free diet together with diuretics. In case of recurrent hydrothorax, a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant should be considered. Here we describe an 80-year-old woman with decompensated liver cirrhosis related to NASH who presented with refractory hepatic hydrothorax. Treatment with CPAP resulted in a marked improvement in her pleural effusion.
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- 2022
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28. The impact and role of hepatic hydrothorax in the prognosis of patients with decompensated cirrhosis: A retrospective propensity score-matched study
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Bo Ma, Tianling Shang, Jianjie Huang, Zhixin Tu, Yan Wang, Yujin Han, Xiaoyu Wen, and Qinglong Jin
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hepatic hydrothorax ,decompensated cirrhosis ,portal hypertension ,prognostic ,liver disease ,Medicine (General) ,R5-920 - Abstract
Background and aimsHepatic Hydrothorax (HH) is one of the complications in patients with decompensated cirrhosis and its impact and role in the prognosis of patients with decompensated cirrhosis are not yet clear. Thus, this study aimed to determine the role of HH in patients with decompensated cirrhosis and the long-term impact on their mortality.Materials and methodsA retrospective study analyzed 624 patients with ascites without pleural effusion in decompensated cirrhosis and 113 patients with HH. Propensity scores were calculated based on eight variables, and the HH and non-HH groups were matched in a 1:1 ratio. The effect and role of HH on the prognosis of patients with decompensated cirrhosis was analyzed using the Kaplan–Meier method and Cox proportional hazards regression model.ResultsA total of 737 patients were included. Out of 113 HH patients, 106 could be matched to 106 non-HH patients. After matching, baseline characteristics were well-balanced. The multifactorial Cox proportional hazards model indicated that hepatic encephalopathy and HH were independent risk factors affecting prognostic survival in patients with decompensated cirrhosis (P < 0.01), with risk ratios and 95% confidence intervals (CI) of 2.073 (95% CI: 1.229–3.494, P < 0.01) and 4.724 (95% CI: 3.287–6.789, P < 0.01), respectively. Prognostic survival was significantly worse in the HH group compared to patients in the non-HH group, with mortality rates of 17.9, 30.1, and 59.4% at 6 months, 1 year, and 2 years in the HH group, compared to 0.9, 3.8, and 5.6% in the non-HH group, respectively. The estimated median survival time was 21 (95% CI: 18–25) months in the HH group and 49 (95% CI: 46–52) months in the non-HH group (P < 0.001).ConclusionHepatic hydrothorax is significantly associated with higher mortality in patients with decompensated cirrhosis and is a highly negligible independent decompensated event affecting their prognosis.
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- 2022
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29. Analysis of clinical features and prognostic factors in patients with hepatic hydrothorax: a single-center study from China.
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Ma, Bo, Shang, Tianling, Huang, Jianjie, Tu, Zhixin, Wang, Yan, Han, Yujin, Wen, Xiaoyu, and Jin, Qinglong
- Abstract
Background: The clinical features and factors affecting the prognostic survival of hepatic hydrothorax (HH) are currently unknown.Methods: We conducted a retrospective cohort study of 131 patients with HH using the Kaplan-Meier method and Cox proportional hazards regression analysis to assess factors influencing the prognosis of HH.Results: A total of 131 patients were enrolled: the male to female ratio was 80:51 (1.59:1), and the mean age was 52.76 ± 11.88 years. Hepatitis B cirrhosis was the main cause of HH, and abdominal distention and dyspnea were the most common clinical signs. Ascites was present in varying amounts in all patients and was the most common decompensated complication, with pleural effusions mostly seen on the right side (107/131; 82%), followed by the left side (16/131; 12%) and bilateral effusions (8/131; 6%). For overall survival without transplantation, the estimated median survival time was 21 (95% confidence interval [CI]:18-25) months, and survival rates at 6 months, 1 year, and 2 years were 77.2%, 62.4%, and 29.7%, respectively. After controlling for covariates that were associated with liver-related mortality in the univariate analysis, males (hazard ratio [HR]: 1.721, 95% CI: 1.114-2.658, P = 0.005) and combined hepatic encephalopathy (HR: 2.016, 95% CI: 1.101-3.693, P = 0.001) were found to be associated with an increase in liver-related mortality.Conclusions: In this cohort of HH patients without liver transplantation, male sex and hepatic encephalopathy were associated with a higher risk of liver-related death. [ABSTRACT FROM AUTHOR]- Published
- 2022
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30. Pleurovenous Shunt Placement for the Management of Nonmalignant Pleural Effusion.
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Awwad, Andy, Berman, Zach, and Minocha, Jeet
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PLEURAL effusions , *SURGICAL anastomosis , *PATIENT selection , *SURGICAL complications , *TREATMENT effectiveness , *CHEST paracentesis - Abstract
Therapeutic thoracentesis is a first-line therapy in the management of patients with medically refractory, nonmalignant pleural effusion. However, when required in short intervals, serial thoracenteses can lead to increased procedure-related complications and negatively impact quality of life. Alternative treatment options vary depending on the etiology of fluid accumulation. Hepatic hydrothorax secondary to cirrhosis is a common cause of medically refractory pleural effusion encountered by interventional radiologists. In select patients in whom surgical pleurodesis, transjugular intrahepatic portosystemic shunt placement, and/or tunneled pleural catheter placement cannot be performed or provide inadequate relief, implantation of a pleurovenous (Denver) shunt may assist in palliation. The Denver shunt system allows decompression of pleural fluid into the central venous circulation by utilizing unidirectional valves and a manually operated subcutaneous pump. Though limited reports have described favorable technical and clinical success, more research is required to determine the safety and efficacy of this procedure. This article discusses pleurovenous shunt placement, postprocedure shunt evaluation, and potential associated complications. [ABSTRACT FROM AUTHOR]
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- 2022
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31. Risk Factors for Hepatic Hydrothorax in Cirrhosis Patients with Ascites - A Clinical Cohort Study.
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Deleuran, Thomas, Watson, Hugh, Vilstrup, Hendrik, and Jepsen, Peter
- Abstract
Background: The risk factors for hepatic hydrothorax are unknown.Methods: We used data from three randomized trials of satavaptan treatment in patients with cirrhosis and ascites followed for up to 1 year. We excluded patients with previous hepatic hydrothorax or other causes for pleural effusion. The candidate risk factors were age, sex, heart rate, mean arterial pressure, diuretic-resistant ascites, a recurrent need for paracentesis, diabetes, hepatic encephalopathy, International Normalized Ratio, creatinine, bilirubin, albumin, sodium, platelet count, use of non-selective beta-blockers (NSBBs), spironolactone, furosemide, proton pump inhibitors, and insulin. We identified risk factors using a Fine and Gray regression model and backward selection. We reported subdistribution hazard ratios (sHR) for hepatic hydrothorax. Death without hepatic hydrothorax was a competing risk.Results: Our study included 942 patients, of whom 41 developed hepatic hydrothorax and 65 died without having developed it. A recurrent need for paracentesis (sHR: 2.55, 95% CI: 1.28-5.08), bilirubin (sHR: 1.18 per 10 µmol/l increase, 95% CI: 1.09-1.28), diabetes (sHR: 2.49, 95% CI: 1.30-4.77) and non-use of non-selective beta-blockers (sHR: 2.27, 95% CI: 1.13-4.53) were risk factors for hepatic hydrothorax. Development of hepatic hydrothorax was associated with a high mortality-hazard ratio of 4.35 (95% CI: 2.76-6.97).Conclusions: In patients with cirrhosis and ascites, risk factors for hepatic hydrothorax were a recurrent need for paracentesis, a high bilirubin, diabetes and non-use of NSBBs. Among these patients with cirrhosis and ascites, development of hepatic hydrothorax increased mortality fourfold. [ABSTRACT FROM AUTHOR]- Published
- 2022
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32. Postoperative Trapped Lung After Orthotopic Liver Transplantation is a Predictor of Increased Mortality.
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Cuk, Natasha, Melamed, Kathryn H., Vangala, Sitaram, Salah, Ramy, Miller, W. Dwight, Swanson, Sarah, Dai, David, Antongiorgi, Zarah, Tisha Wang, Agopian, Vatche G., Dinorcia, Joseph, Farmer, Douglas G., Yanagawa, Jane, Kaldas, Fady M., and Barjaktarevic, Igor
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- *
LIVER transplantation , *PREOPERATIVE risk factors , *PLEURAL effusions , *LUNGS , *OPERATIVE surgery , *KIDNEY transplantation - Abstract
Pleural effusions are a common complication of orthotopic liver transplantation (OLT), and chronic post-OLT pleural effusions have been associated with worse outcomes. Furthermore, "trapped lung" (TL), defined as a restrictive fibrous visceral pleural peel preventing lung re-expansion, may have prognostic significance. We performed a retrospective analysis of adult OLT recipients over a 9-year period at UCLA Medical Center. Post-OLT patients with persistent pleural effusions, defined by the presence of pleural fluid requiring drainage one to 12 months after OLT, were included for analysis. Outcomes for patients with and without TL were compared using univariate and multivariate analysis. Of the 1722 patients who underwent OLT, 117 (7%) patients met our criteria for persistent postoperative pleural effusion, and the incidence of TL was 21.4% (25/117). Compared to patients without TL, those with TL required more surgical pleural procedures (OR 59.8, 95%CI 19.7-181.4, p < 0.001), spent more days in the hospital (IRR 1.56, 95%CI 1.09-2.23, p = 0.015), and had a higher risk of mortality (HR 2.47, 95%CI 1.59-3.82, p < 0.001) following transplant. In sum, we found that post-OLT TL was associated with higher morbidity, mortality, and healthcare utilization. Future prospective investigation is warranted to further clarify the risk factors for developing postoperative pleural effusions and TL. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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33. Spontaneous bacterial empyema: a tertiary care center experience and a systematic review.
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Osman, Karim T., Mehta, Neev, Spencer, Carol, and Qamar, Amir A.
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EMPYEMA ,MICROBIAL cultures ,TERTIARY care ,LEUKOCYTE count ,LIVER transplantation ,TRANSPLANTATION of organs, tissues, etc. - Abstract
Spontaneous bacterial empyema (SBE) is an infection of a preexisting hepatic hydrothorax (HH). We aim to describe the experience in managing SBE in a liver transplant (LT) referral center and assessing the incidence and mortality rates of SBE after conducting a systematic review. 992 patients with cirrhosis were retrospectively reviewed from 2015 to 2020. SBE was diagnosed by (i) positive microbiological culture and polymorphonuclear leukocyte count >250 cells/µL or (ii) negative microbiological culture, compatible clinical course, and polymorphonuclear count >500 cells/µL in pleural fluid. Furthermore, we conducted a comprehensive literature search of MEDLINE, EMBASE, and Google Scholar for studies evaluating SBE. Twelve patients (10.4%) had spontaneous bacterial empyema out of 115 patients with HH. Five patients underwent LT, 6 had died, and 1 did not get transplanted and was alive throughout the duration of follow-up. Ten studies were included in the systematic review. Pooled incidence in patients with HH was 19.03%. Only 20.69% of the patients received a LT. Pooled mortality rate was 46.45%, with only 3.45% of the patients dying post-transplant. SBE is a severe complication of cirrhosis and HH. LT may provide a survival benefit. Thus, patients should be considered for early transplant. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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34. Rare Presentation of Isolated Spontaneous Bacterial Empyema without Concomitant Ascites in a Patient with Cirrhosis.
- Author
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Dharmalingam, Anbu Krithigha, Pandurangan, Viswanathan, Ramadurai, Srinivasan, Arthur, Preetam, Lakshmanan, Suja, and Nair, Aiswarya M.
- Subjects
- *
ANTIBIOTICS , *DIURETICS , *CHEST X rays , *PLEURAL effusions , *PLEURODESIS , *CIRRHOSIS of the liver , *ASCITES , *PORTAL hypertension , *EMPYEMA , *DISEASE complications , *SYMPTOMS - Abstract
In decompensated cirrhosis, massive ascites and pleural effusion (hepatic hydrothorax) can be complicated by infection, which manifests either as spontaneous bacterial peritonitis (SBP) or spontaneous bacterial empyema (SBE). SBE is a distinct and often underdiagnosed complication having different pathogenesis and treatment strategy when compared with parapneumonic empyema. Hepatic hydrothorax in the absence of ascites is rare in patients with cirrhosis. The occurrence of SBE without SBP or ascites is even more of a rarity in cirrhosis and carries great morbidity and mortality. Here we report a case of an elderly female patient with cirrhosis (Child-Pugh Class B) who had unusual features of isolated right-sided hepatic hydrothorax without clinically evident ascites and was later diagnosed as having SBE based on imaging of the thorax, pleural fluid analysis, and cultures. The patient was initially treated conservatively with antibiotics, and diuretics, and later pigtail insertion and drainage was done. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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35. Implications of Pleural Fluid Composition in Persistent Pleural Effusion following Orthotopic Liver Transplant
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Bhavesh H. Patel, Kathryn H. Melamed, Holly Wilhalme, Gwenyth L. Day, Tisha Wang, Joseph DiNorcia, Douglas Farmer, Vatche Agopian, Fady Kaldas, and Igor Barjaktarevic
- Subjects
hepatic hydrothorax ,orthotopic liver transplantation ,exudative pleural effusion ,Light’s criteria ,Medicine - Abstract
Persistent pleural effusions (PPEf) represent a known complication of orthotopic liver transplant (OLT). However, their clinical relevance is not well described. We evaluated the clinical, biochemical, and cellular characteristics of post-OLT PPEf and assessed their relationship with longitudinal outcomes. We performed a retrospective cohort study of OLT recipients between 2006 and 2015. Included patients had post-OLT PPEf, defined by effusion persisting >30 days after OLT and available pleural fluid analysis. PPEf were classified as transudates or exudates (ExudLight) by Light’s criteria. Exudates were subclassified as those with elevated lactate dehydrogenase (ExudLDH) or elevated protein (ExudProt). Cellular composition was classified as neutrophil- or lymphocyte-predominant. Of 1602 OLT patients, 124 (7.7%) had PPEf, of which 90.2% were ExudLight. Compared to all OLT recipients, PPEf patients had lower two-year survival (HR 1.63; p = 0.002). Among PPEf patients, one-year mortality was associated with pleural fluid RBC count (p = 0.03). While ExudLight and ExudProt showed no association with outcomes, ExudLDH were associated with increased ventilator dependence (p = 0.03) and postoperative length of stay (p = 0.03). Neutrophil-predominant effusions were associated with increased postoperative ventilator dependence (p = 0.03), vasopressor dependence (p = 0.02), and surgical pleural intervention (p = 0.02). In summary, post-OLT PPEf were associated with increased mortality. Ninety percent of these effusions were exudates by Light’s criteria. Defining exudates using LDH only and incorporating cellular analysis, including neutrophils and RBCs, was useful in predicting morbidity.
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- 2023
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36. Pulmonary Complications of Portal Hypertension.
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Bommena S and Fallon MB
- Subjects
- Humans, Hypertension, Portal etiology, Hypertension, Portal complications, Hypertension, Portal physiopathology, Hepatopulmonary Syndrome etiology, Hepatopulmonary Syndrome physiopathology, Hepatopulmonary Syndrome therapy, Hydrothorax etiology, Hydrothorax therapy, Hypertension, Pulmonary etiology, Hypertension, Pulmonary physiopathology, Liver Transplantation
- Abstract
Portopulmonary hypertension (POPH), hepatopulmonary syndrome, and hepatic hydrothorax constitute significant complications of portal hypertension, with important implications for management and liver transplantation (LT) candidacy. POPH is characterized by obstruction and remodeling of the pulmonary resistance arterial bed. Hepatopulmonary syndrome is the most common pulmonary vascular disorder, characterized by intrapulmonary vascular dilatations causing impaired gas exchange. LT may improve prognosis in select patients with POPH. LT is the only effective treatment of hepatopulmonary syndrome. Hepatic hydrothorax is defined as transudative pleural fluid accumulation that is not explained by primary cardiopulmonary or pleural disease. LT is the definitive cure for hepatic hydrothorax., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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37. Pleural Interventions in the Management of Hepatic Hydrothorax.
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Gilbert, Christopher R., Shojaee, Samira, Maldonado, Fabien, Yarmus, Lonny B., Bedawi, Eihab, Feller-Kopman, David, Rahman, Najib M., Akulian, Jason A., and Gorden, Jed A.
- Subjects
- *
HYDROTHORAX , *PLEURODESIS , *TRANSPLANTATION of organs, tissues, etc. , *CATHETERIZATION , *RESPIRATORY insufficiency , *PORTAL hypertension , *CRITICAL care medicine , *PLEURAL effusions , *CHEST (Anatomy) , *CIRRHOSIS of the liver , *CHEST tubes , *LIVER diseases , *PLEURA diseases , *THORACOSTOMY , *DISEASE management , *CATHETERS , *DISEASE complications - Abstract
Hepatic hydrothorax can be present in 5% to 15% of patients with underlying cirrhosis and portal hypertension, often reflecting advanced liver disease. Its impact can be variable, because patients may have small pleural effusions and minimal pulmonary symptoms or massive pleural effusions and respiratory failure. Management of hepatic hydrothorax can be difficult because these patients often have a number of comorbidities and potential for complications. Minimal high-quality data are available for guidance specifically related to hepatic hydrothorax, potentially resulting in pulmonary or critical care physician struggling for best management options. We therefore provide a Case-based presentation with management options based on currently available data and opinion. We discuss the role of pleural interventions, including thoracentesis, tube thoracostomy, indwelling tunneled pleural catheter, pleurodesis, and surgical interventions. In general, we recommend that management be conducted within a multidisciplinary team including pulmonology, hepatology, and transplant surgery. Patients with refractory hepatic hydrothorax that are not transplant candidates should be managed with palliative intent; we suggest indwelling tunneled pleural catheter placement unless otherwise contraindicated. For patients with unclear or incomplete hepatology treatment plans or those unable to undergo more definitive procedures, we recommend serial thoracentesis. In patients who are transplant candidates, we often consider serial thoracentesis as a standard treatment, while also evaluating the role indwelling tunneled pleural catheter placement may play within the course of disease and transplant evaluation. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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38. One‐year outcome of patients with cirrhosis who developed spontaneous bacterial empyema: A cohort study.
- Author
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Jiménez‐Gutiérrez, José M., García‐Juárez, Ignacio, Olivas‐Martinez, Antonio, and Ruiz, Isaac
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EMPYEMA , *CARDIOVASCULAR diseases risk factors , *COHORT analysis , *TREATMENT effectiveness , *CIRRHOSIS of the liver , *LIVER transplantation , *TRANSPLANTATION of organs, tissues, etc. , *PARACENTESIS - Abstract
Objective: This study aimed to evaluate outcomes in cirrhotic patients diagnosed with spontaneous bacterial empyema (SBE) compared with those without this complication. Methods: We performed a retrospective cohort study of cirrhotic patients from a tertiary care center. The primary outcome was time to death or liver transplantation (LT) within one year after diagnosis of infection. We integrated three groups: patients with SBE (group A), patients with spontaneous bacterial peritonitis (SBP; group B), and cirrhotic patients without SBP or SBE (group C), matched by age, model for end‐stage liver disease‐sodium (MELD‐Na) score and year of infection. Outcomes were analyzed using a Cox regression model adjusted for cardiovascular risk factors and MELD‐Na score. Results: Between January 1999 and February 2019, 4829 cirrhotic patients were identified. Among them, 73 (1.5%) had hepatic hydrotorax, of whom 22 (30.1%) were diagnosed with SBE. Median age in group A was 58 years, 50% were men, and median MELD‐Na was 21.5. Compared with group C, the hazard ratio of death or LT during the first year after infection was 2.98 (95% confidence interval [CI] 1.43‐6.22, P = 0.004) for group A and 1.23 (95% CI 0.65‐2.32, P = 0.522) for group B. Conclusions: Our results suggest that patients with SBE have a worse outcome during the first year after infection is diagnosed. Patients who develop SBE should be promptly referred for transplant evaluation. SBE may emerge as new indication that could benefit from MELD exception points. [ABSTRACT FROM AUTHOR]
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- 2021
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39. Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis.
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Rendón-Ramírez, Erick Joel, González-Villarreal, Marusia, Muñoz-Espinoza, Linda Elsa, Colunga–Pedraza, Perla Rocío, Moreno, Juan Francisco, Salinas-Chapa, Matias, Mercado-Longoria, Roberto, Treviño-García, Karla Belén, Cazares-Rendón, Erika, Porcel, José M., and Colunga-Pedraza, Perla Rocío
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ULTRASONIC imaging , *PLEURAL effusions , *SURVIVAL rate , *CIRRHOSIS of the liver , *POINT-of-care testing - Abstract
Chronic liver disease (CLD) may be associated with pleural effusions (PEs). This article prospectively evaluates whether detection of PEs on thoracic ultrasound (TUS) at the bedside independently predicts mortality and length of stay (LOS) in hospitalized patients with a decompensated CLD. A total of 116 consecutive inpatients with decompensated cirrhosis underwent antero-posterior chest radiographs (CXR) and TUS to detect PEs. Their median age was 54 y (interquartile range, 47-62), 90 (70.6%) were male, and 61 (52.6%) fell into the Child-Pugh class C categorization. TUS identified PEs in 58 (50%) patients, half of which were small enough to preclude thoracentesis. CXR failed to recognize approximately 40% of PEs seen on TUS. The identification of PEs by TUS was associated with a longer LOS (10 vs. 5.5 d, p < 0.001) and double mortality (39.7% vs. 20.7%, p = 0.021). In multivariate analysis, PEs were independently related to poor survival (hazard ratio 2.08, 95% confidence interval [CI] 1.02-4.25; p = 0.044). Patients with both Child-Pugh C stage and PEs had the lowest survival rate (70 vs. 317 d, p = 0.001). In conclusion, PEs identified by TUS in hospitalized patients with decompensated CLD independently predict a poor outcome and portend a longer LOS. [ABSTRACT FROM AUTHOR]
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- 2021
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40. Medical thoracoscopy with talc pleurodesis for refractory hepatic hydrothorax: A case series of three successes.
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Rahim, Y., Reddy, R.V., Naeem, M., and Tsaknis, G.
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Medical thoracoscopy with chemical pleurodesis is a last resort for managing patients who suffer. from recurrent hepatic hydrothorax. However, despite pleurodesis, the rapid fluid build-up can hinder the successful apposition of the pleural surfaces. To improve the chances of success, we investigated the effectiveness of abdominal paracentesis before chemical pleurodesis via medical thoracoscopy to reduce significant fluid shifts from the peritoneal to the pleural cavity. We present a series of three patients with liver cirrhosis complicated by hepatic hydrothorax who underwent medical thoracoscopy with talc pleurodesis. Before the procedure, we optimised medical treatment, and if needed, we performed large-volume paracentesis to prevent rapid reaccumulation of pleural fluid. All study subjects achieved treatment success, defined as relief of breathlessness and absence of pleural effusion at 12 months. Complications related to the treatment included hepatic encephalopathy and acute kidney injury, which were managed conservatively. To manage symptomatic and recurrent hepatic hydrothorax, medical thoracoscopy with talc pleurodesis, preceded by the evacuation of ascites, can be considered as a treatment option. This procedure should be considered early for those who do not respond to medical management and are not suitable candidates for TIPS or liver transplantation. [ABSTRACT FROM AUTHOR]
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- 2024
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41. Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation
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Mayurun Selvan, Hannah Collins, William Griffiths, William Gelson, and Jurgen Herre
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indwelling pleural catheter ,hepatic hydrothorax ,liver transplantation ,pleural disease ,case series ,Medicine (General) ,R5-920 - Abstract
Introduction: Liver transplantation is the treatment of choice for decompensated liver disease, and by extension for hepatic hydrothorax. Persistent pleural effusions make it challenging for patients to maintain physiological fitness for transplantation. Indwelling pleural catheters (IPCs) provide controlled pleural fluid removal, including peri-operatively. The immune dysfunction of cirrhosis heightens susceptibility to bacterial infection and concerns exist regarding the sepsis potential from a tunnelled drain.Method: Six patients were identified who underwent IPC insertion for hepatic hydrothorax before successful liver transplantation, between November 2016 and November 2017.Results: All patients had recurrent transudative right sided pleural effusions. Mean age was 49 years (range 24–64) and mean United Kingdom Model for End-Stage Liver Disease score was 58. Four patients required correction of coagulopathy before insertion. There were no complications secondary to bleeding. Three patients were taught self-drainage at home of up to 1 litre (L) daily. A protocol was developed to ensure weekly review, pleural fluid culture and drainage of larger volumes in hospital. For every 2–3 L of pleural fluid drained, 100 mls of 20% Human Albumin Solution (HAS) was administered. On average an IPC was in situ for 58 days before surgery and drained 19 L of fluid in hospital. There was a small increase in average BMI (0.2) and serum albumin (2.1 g/L) at transplantation. There was one episode of stage one acute kidney injury secondary to high volume drainage. No further ascitic or pleural procedures were needed while an IPC was in situ. One thoracentesis was required after IPC removal. On average IPCs remained in situ for 7 days post transplantation and drained a further 2 L of fluid. Pleural fluid sampling was acquired on 92% of drainages in hospital. Of 44 fluid cultures, 2 cultured bacteria. Two patients had their IPCs and all other lines removed post transplantation due to suspected infection.Conclusion: Our case series describes a novel protocol and successful use of IPCs in the management of refractory hepatic hydrothorax as a bridge to liver transplantation. The protocol includes albumin replacement during pleural drainage, regular clinical review and culture of pleural fluid, with the option of self-drainage at home.
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- 2021
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42. Preoperative Trapped Lung Is Associated With Increased Mortality After Orthotopic Liver Transplantation.
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Melamed, Kathryn H., Dai, David, Cuk, Natasha, Markovic, Daniela, Follett, Robert, Wang, Tisha, Lopez, Roxana Cortes, Shirali, Aditya S., Yanagawa, Jane, Busuttil, Ronald, Kaldas, Fady, and Barjaktarevic, Igor
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SURGICAL complication risk factors ,MORTALITY risk factors ,PLEURAL effusions ,CONFIDENCE intervals ,PREOPERATIVE period ,LUNGS ,LOG-rank test ,RETROSPECTIVE studies ,MANN Whitney U Test ,FISHER exact test ,DESCRIPTIVE statistics ,LIVER transplantation ,ATELECTASIS ,DATA analysis software ,LIVER failure ,PNEUMOTHORAX ,LONGITUDINAL method ,DISEASE complications - Abstract
Introduction: Trapped lung, characterized by atelectatic lung unable to reexpand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease complicated by hepatic hydrothorax. Limited data suggest that trapped lung prior to orthotopic liver transplantation may be associated with poor outcomes. Research Question: What is the clinical significance of trapped lung in patients receiving orthotopic liver transplantation? Design: We performed a retrospective analysis of patients who underwent liver transplantation over an 8-year period. Baseline clinical characteristics and postoperative outcomes of adult patients with trapped lung were analyzed and compared to the overall cohort of liver transplant recipients and controls matched 3:1 based on age, sex, Model for End-Stage Liver Disease (MELD) score, and presence of pleural effusion. Results: Of the 1193 patients who underwent liver transplantation, we identified 20 patients (1.68%) with trapped lung. The probability of 1 and 2-year survival were 75.0% and 57.1%, compared to 85.6% and 80.4% (p = 0.02) in all liver transplant recipients and 87.9% and 81.1% (p = 0.03) in matched controls respectively. Patients with trapped lung had a longer hospital length of stay compared to the total liver transplant population (geometric mean 54.9 ± 8.4 vs. 27.2 ± 0.7 days, p ≤ 0.001), when adjusted for age and MELD score. Discussion: Patients with trapped prior to orthotopic liver transplantation have increased probability of mortality as well as increased health care utilization. This is a small retrospective analysis, and further prospective investigation is warranted. [ABSTRACT FROM AUTHOR]
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- 2021
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43. Recurrent Left-Sided Hepatic Hydrothorax Leading to Liver-Mediated Dyspnea.
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Trivedi D, Li K, Ahmed S, Fenton F, and Shahzad S
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Cirrhosis is a common liver condition caused by several etiologies including alcohol use disorder, infectious hepatitis, and metabolic dysfunction associated with liver disease. Although common symptomatic complications of cirrhosis include malaise, gastrointestinal bleeding, and abdominal distension, shortness of breath is a less common phenomenon that may occur. Hepatic hydrothorax (HH) is an uncommon cause of shortness of breath that is believed to be caused by the accumulation of ascitic fluid in the pleural space. While most cases of HH occur with ascites and the right side, we hereby present a case of a 70-year-old female with left-sided HH without ascites., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Trivedi et al.)
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- 2024
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44. Iatrogenically Acquired Mycobacterium abscessus Infection in an Indwelling Intercostal Drainage In Situ in a Patient With Alcoholic Liver Disease and Bilateral Hepatic Hydrothorax: A Report of a Rare Case.
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Ranjan R, Gunasekaran J, Bir R, Kumar U, and Gupta RM
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A 47-year-old male, a known case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath. A provisional diagnosis of ethanol-related compensated chronic liver disease (CLD) with portal hypertension and splenomegaly, gross ascites with bilateral hepatic hydrothorax was made. The left-sided pleural effusion subsided after three pleural taps, but the right-sided effusion kept refilling even after four to five days of repeated therapeutic taps, so a pigtail catheter was left in situ. The pleural fluid was sent for culture which did not grow any pathogenic organisms. Cartridge-based nucleic acid amplification tests where Mycobacterium tuberculosis complex (MTBC) was not detected, Ziehl-Neelsen staining was done in which acid-fast bacilli were not seen, and cytology was done where no malignant cells were seen. The patient was discharged with the pigtail in situ on the right side and, after 20 days, the patient again presented with shortness of breath, and imaging revealed moderate right-side pleural effusion. Draining of pleural fluid was done and sent for investigation which again revealed no infective etiology. The patient was admitted to the hospital for one month as the right-sided effusion did not resolve. Suddenly, the patient developed shortness of breath, and a chest X-ray was done, which showed pigtail blockage; pigtail flushing was done, and the bag was drained. The patient was empirically started on IV meropenem 500 mg TID, IV teicoplanin 400 mg BD, and inj polymyxin B 500,000 IU IV BD. The pleural fluid was sent continuously for investigation for the first two months which again did not reveal any infective etiology. After two months of pigtail in situ, the pleural fluid was sent for CBNAAT where MTBC was not detected, and ZN stain showed smooth acid-fast bacilli. The sample was cultured, and it grew acid-fast bacilli in 72 hours on blood agar, MacConkey agar, and Lowenstein-Jensen media. A line probe assay done from the isolate revealed it to be Mycobacterium abscessus subsp. abscessus which was resistant to macrolides and sensitive to aminoglycosides. Mycobacterium abscessus subsp. abscessus was isolated from repeated cultures of pleural fluid, and the patient was advised on a combination treatment of amikacin, tigecycline, and imipenem. The patient was discharged with the indwelling pigtail with the advised treatment; unfortunately, we lost patient follow-up as the patient never returned to us., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ranjan et al.)
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- 2024
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45. Surgical repair of hepatic hydrothorax caused by diaphragmatic fistula
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Miho Ikeda, Yukihisa Hatakeyama, Shoko Murakami, Rika Hashimoto, Shunsuke Tauchi, Yuriko Yonekura, and Hisashi Ohnishi
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Hepatic hydrothorax ,Primary biliary cholangitis ,Diaphragmatic fistula ,Thoracoscopic surgery ,Diseases of the respiratory system ,RC705-779 - Abstract
A 65-year-old woman visited our hospital complaining of dyspnea several days before admission. A chest X-ray showed massive right-sided pleural effusion, which was not observed 1 month previously. Although the patient had never been diagnosed with cirrhosis at regular visits, the patient was diagnosed with primary biliary cholangitis at admission. Hepatic hydrothorax was suspected because pleural effusion was transudative. A diaphragmatic fistula was confirmed and closed by thoracoscopy. Pleural effusion did not reappear after this procedure. Existence of a diaphragmatic defect should be confirmed under direct vision if pleural effusion accumulates acutely or becomes beyond control.
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- 2021
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46. Efficacy of central venous catheter in pleurodesis in refractory hepatic hydrothorax
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Adel H.A Ghoneim, Mohamed Sobh El Gammal, Mohamed M.N AboZaid, and Ahmad Abd El Rahman
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hepatic hydrothorax ,liver cirrhosis ,pleurodesis ,Diseases of the respiratory system ,RC705-779 - Abstract
Background Hepatic hydrothorax is an important complication of cirrhosis and portal hypertension. Recurrent hepatic hydrothorax may be difficult to manage. In cases where medical therapies, usually diuretics, have failed to adequately control symptomatic effusion, thoracentesis, thoracostomy tube drainage, and pleurodesis have been employed. Tunneled pleural catheters are used for control and long-term management of recurrent pleural effusions. The aim of management of recurrent effusion in patients with hepatic hydrothorax is to relieve symptoms, to decrease discomfort of the patient through repeated aspiration, and chemical pleurodesis to prevent recurrence. Intrapleural chemical agents including tetracycline, doxycycline, bleomycin, talc insufflations, or talc slurry are used for pleurodesis. Tetracycline is the most common agent. A central venous catheter is a thin, long flexible tube that may be inserted into the pleural space. Objectives The aim of this study is to explore the efficacy, safety, and tolerability of central venous catheter in pleurodesis by tetracycline to relieve distressing symptoms and prevent fluid re-accumulation in patients with recurrent hepatic hydrothorax. Patients and methods This study recruited 22 patients with hepatic hydrothorax to evaluate the effectiveness of the small-bore central venous line in draining the pleural cavity as well as to evaluate the effectiveness of the intrapleural tetracycline as a sclerosing agent. Results Regarding the success rate of pleurodesis in the studied patients, the procedure was successful in 16 (72.7%) cases and failed in six (27.3%) cases. Regarding the reported complications, chest pain was the most commonly reported complication followed by dyspnea, fever, and tachycardia. Conclusion Central venous catheters are small and flexible and allow the patients to move easily offering a wonderful, comfortable, and tolerable method for drainage and pleurodesis.
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- 2019
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47. Successful treatment of hepatic hydrothorax: A case report
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Mariam Jmal, Maroi Dammak, Olfa Chakroun-Walha, and Noureddine Rekik
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hepatic hydrothorax ,management ,chest tube ,medical treatment ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Rationale: Acute complications of cirrhosis can be life- threatening. One of the less common acute complications is hepatic hydrothorax whose medical management is rarely successful and is still controversial. Patient concerns: A 51-year-old patient presenting to the emergency room for a massive pleural effusion. Diagnosis: A hepatic hydrothorax with a placed chest tube whose removal was not possible. Interventions: Increased doses of diuretics with a strict salt-free diet. Outcomes: An improvement of the clinical state, with no recurrent pleural effusion up to one month. Lessons: Medical management of hepatic hydrothorax is possible.
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- 2020
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48. Minimally invasive surgical strategy for refractory hepatic hydrothorax.
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Jung, Yochun, Song, Sang Yun, Na, Kook Joo, Chon, Soon-Ho, Jun, Chung Hwan, and Choi, Sung Kyu
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HYDROTHORAX , *PLEURODESIS , *PLEURAL effusions , *MINIMALLY invasive procedures , *CIRRHOSIS of the liver - Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES Treatment of refractory hepatic hydrothorax, a complication of liver cirrhosis, is complex. We aimed to investigate the usefulness of the '4-step approach', which is a minimally invasive surgical strategy combining 4 therapeutic modalities: (i) pneumoperitoneum to localize diaphragmatic defects; (ii) thoracoscopic pleurodesis; (iii) postoperative positive-pressure ventilation; and (iv) peritoneal drainage for abdominal decompression. METHODS We retrospectively analysed the medical records of 12 patients with hepatic hydrothorax who underwent surgical treatment using the 4-step approach from January 2013 to December 2017. Nine of them (75.0%) were Child C cases; the median model for end-stage liver disease score was 20.5. The diaphragmatic defects localized after forming a pneumoperitoneum were treated with primary closure followed by thoracoscopic pleurodesis, postoperative positive-pressure ventilation and peritoneal drainage. RESULTS Diaphragmatic defects were localized in all patients except one. The median postoperative positive-pressure ventilation duration was 20.1 h. Peritoneal drainage was performed for a median duration of 5 days; the peritoneal drains were removed at a median of 8 postoperative days. The median duration of postoperative hospital stay until discharge/transfer was 9.5 days. No operative mortalities occurred. The median duration of follow-up was 10.9 months. Eight deaths (66.7%) occurred during the follow-up period; however, no deaths were surgery-associated. Ipsilateral pleural effusion recurred in 3 patients (25%), among whom reoperation was performed in 1 without recurrence at the 13-month follow-up. CONCLUSIONS The 4-step approach seems to be a safe and effective minimally invasive surgical strategy for treating refractory hepatic hydrothorax. [ABSTRACT FROM AUTHOR]
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- 2020
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49. Management of hepatic hydrothorax and effect on length of stay, mortality, cost, and 30‐day hospital readmission.
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Sobotka, Lindsay A, Spitzer, Carleen, Hinton, Alice, Michaels, Anthony, Hanje, A James, Mumtaz, Khalid, and Conteh, Lanla F
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LENGTH of stay in hospitals , *HYDROTHORAX , *PATIENT readmissions , *CHEST paracentesis , *THORACOSCOPY , *NOSOLOGY , *BILIARY liver cirrhosis , *HOSPITAL costs , *PLEURAL effusions - Abstract
Background and Aim: Cirrhosis‐related complications are associated with high inpatient mortality, cost, and length of stay. There is a lack of multi‐centered studies on interventions for hepatic hydrothorax and its impact on patient outcomes. The aim of this study was to determine the effect of performing thoracentesis for hepatic hydrothorax on hospital length of stay, mortality, cost, and 30‐day readmission. Methods: A retrospective analysis of the Nationwide Inpatient Sample between 2002 and 2013 and Nationwide Readmission Database during 2013 was performed including patients with a primary diagnosis of hydrothorax or pleural effusion and a secondary diagnosis of cirrhosis based on International Classification of Disease 9 codes. Univariate and multivariate analyses were performed to determine the effect of thoracentesis on patient outcomes during their hospital stay. Results: Of the 37 443 patients included from the Nationwide Inpatient Sample, 26 889 (72%) patients underwent thoracentesis. Thoracentesis was associated with a longer length of stay (4.56 days, 95% confidence interval [CI]: 2.40–6.72) and higher total cost ($9449, 95% CI: 3706–15 191). There was no significant difference in inpatient mortality between patients who underwent thoracentesis compared with those who did not. Of the 2371 patients included from the Nationwide Readmission Database, 870 (33%) were readmitted within 30 days. Thoracentesis was not a predictor of readmission; however, transjugular intrahepatic portosystemic shunt (odds ratio: 4.89, 95% CI: 1.17–20.39) and length of stay (odds ratio: 1.02, 95% CI: 1.001–1.05) on index admission were predictors of readmission. Conclusion: When considering treatment for hepatic hydrothorax, many factors should contribute to determining the best intervention. While performing thoracentesis may provide immediate relief to symptomatic patients, it should not be considered a long‐term intervention given that it increases hospital cost, was associated with longer length of stays, and did not improve mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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50. Thoracoscopic diaphragm repair using abdominal insufflation in a patient with hepatic hydrothorax.
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Omura, Akiisa, Kanzaki, Ryu, Ike, Akihiro, Kanazawa, Go, Kanou, Takashi, Ose, Naoko, Funaki, Soichiro, Minami, Masato, and Shintani, Yasushi
- Abstract
Hepatic hydrothorax refers to significant serous pleural effusion induced by liver cirrhosis, and some reports have suggested that this entity is ascites transferred to the thoracic cavity via a small hole in the diaphragm. There have been a few reports describing radical diaphragmatic repair by suturing the defect. We performed thoracoscopic diaphragmatic repair under abdominal insufflation to clarify the defect points. Air leakage at the diaphragmatic tissue was clearly noted and closed by suturing with polytetrafluoroethylene (PTFE) pledgets. The patient's postoperative course was uneventful, and no recurrence of ascites or hydrothorax has been noted. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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