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PubMed1989

Unilateral hydrothorax in small children on chronic continuous peritoneal dialysis.

Three small children whose weights were under 15 kg and who were on continuous ambulatory peritoneal dialysis or continuous cycling peritoneal dialysis developed massive unilateral hydrothorax. The occurrence of hydrothorax was late, 3-22 months after the initiation of dialysis. Two of the three fluid collections were left-sided. Each episode was preceded by retention of dialysate. After drainage of the hydrothorax a modified peritoneal dialysis regimen was successful in sustaining patients for a few weeks until further therapy for end-stage renal disease could be pursued.

Female↗
PubMedDate not supplied

Tension hydrothorax: a rare complication of continuous cyclical peritoneal dialysis.

Continuous cyclical peritoneal dialysis (CCPD) is a well-established, effective method of maintenance dialysis in patients with end-stage renal disease (ESRD). Massive hydrothorax producing hemodynamic compromise (tension hydrothorax) has been documented as an infrequent complication of both acute temporary peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). We recently saw a patient with massive hydrothorax as a consequence of CCPD. The etiology of this rare condition is thought to be that of a diaphragmatic defect with a one-way valve mechanism. Diagnosis is made by aspiration of the pleural fluid and estimation of pleural fluid glucose. Management of these patients requires pleural drainage and changing to hemodialysis if possible.

Female↗
PubMedDate not supplied

Bilateral hydrothorax caused by left external jugular venous catheter perforation.

We report a case of bilateral hydrothorax secondary to perforation of the superior vena caval wall, which was caused by a double-lumen central venous catheter used for catheterization of the left jugular vein. A patient undergoing craniectomy developed a right pleural effusion followed by a left hydrothorax 12 hours after the operation. There are several possible explanations for this phenomenon. The horizontal course of the left brachiocephalic vein, heart contraction, mechanical ventilation, changes in patient position, and solutions of high osmolality can promote vascular erosion by the catheter tip. High hydrostatic pressure in the thorax associated with a congenital or an acquired interpleural communication may cause bilateral hydrothorax. We suggest that it is always preferable to cannulate a central vein through the right side. When the left external jugular vein has to be cannulated, an intravascular ECG may be helpful to determine the position of the catheter tip. Chest roentgenogram should be obtained early to confirm catheter position. Furthermore, the distal port of the double-lumen central venous catheter should be used perioperatively for continuous surveillance of the central venous pressure waveform to ensure early warning of venous perforation.

Adolescent↗
PubMed2006

Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax.

BACKGROUND: Patients with recurrent, refractory hepatic hydrothorax from porous diaphragm syndrome represent a therapeutic challenge with few options. METHODS: A retrospective review of an electronic prospective database of patients with cirrhosis and refractory hepatic hydrothorax. Patients underwent video-assisted thoracoscopic surgery (VATS) with talc pleurodesis insufflating 2.5 g of talc. Successful therapy was defined as relief of dyspnea and control of symptomatic hydrothorax for a minimum of 6 months after the procedure. RESULTS: There were 41 patients (21 men, median age 55 years), 25 with Child-Pugh class C and 14 with class B, and 2 liver transplant patients. The etiology of the cirrhosis was hepatitis B in 4, hepatitis C in 20, alcohol in 4, cryptogenic cirrhosis in 11, and other in 2. Definitive openings in the diaphragm were seen in only 2 patients. Seven patients (17%) required bedside talc slurry through the chest tube after the intraoperative talc. Overall success was achieved in 80% (33 of 41). Four patients experienced symptomatic fluid reaccumulation at 45, 61, 62, and 102 days and were treated with a repeat VATS, with success in 2. There was 1 operative death (coagulopathy). CONCLUSIONS: Patients with recurrent effusions from porous diaphragm syndrome have few options. Video-assisted thoracoscopic surgery with talc is safe and successful in about three fourths of patients, but repeat talc slurry through the chest tube or repeat VATS is often needed. Video-assisted thoracoscopic surgery provides an effective alternative to transjugular intrahepatic portosystemic shunt and is a bridge toward liver transplantation in patients with few other options.

Adult↗
PubMed2005

Video-assisted thoracoscopic surgery for hydrothorax in peritoneal dialysis patients - check-air-leakage method.

Hydrothorax developing from pleuroperitoneal communication as a complication of peritoneal dialysis was first described in 1967 [Edward SR, Unger AM. Acute hydrothorax-a new complication of peritoneal dialysis. JAMA 1967; 199:853-5. ]. The incidence of hydrothorax is approximately 1.6-2% of continuous ambulatory peritoneal dialysis (CAPD) patients. The key to successful therapy is obliteration of the transdiaphragmatic route of dialysate leakage with video-assisted thoracoscopic surgery (VATS). The method in which air leakage is checked intraoperatively is the preferred choice and better than all other procedures.

Diaphragm↗
PubMed2004

Isotopic exploration of hepatic hydrothorax: ten cases.

OBJECTIVE: The aim of this retrospective study was to evaluate the performance of peritoneal scintigraphy for the diagnosis of peritoneopleural communication in patients with cirrhosis and to discuss its role in therapeutic management. PATIENTS AND METHODS: Ten patients with cirrhosis and pleural effusion were included in this study. Cirrhosis was due to viral hepatitis in eight patients, auto-immune disease in one patient and of unknown origin in one. The pleural effusion was right-sided in nine patients and bilateral in one. 99m-technetium sulfur colloid peritoneal scintigraphy was performed in all patients. RESULTS: Scintigraphy revealed peritoneopleural communication in nine patients. In four patients, radioactivity appeared in the pleural cavity within a few minutes after injection of the radiotracer. In three of them, a large diaphragmatic defect was demonstrated by ultrasonography, magnetic resonance imaging or thoracoscopy. Complete response to medical treatment was observed in four patients. Scintigraphy revealed rapid radioactivity migration in four patients; diuretic treatment led to resolution of the hydrothorax in one of them. Three patients whose hydrothorax was refractory to medical treatment were treated by pleurodesis with talc. Resolution of the hydrothorax was achieved in one of them. CONCLUSION: Peritoneal scintigraphy is a simple non-invasive method enabling confirmation of peritoneopleural communication in cirrhotic patients. The importance of the diaphragmatic defect can also be evaluated, providing a significant contribution to therapeutic decision-making.

Adult↗
PubMed2001

Hydrothorax: an unexpected complication after laparoscopic myomectomy.

We report a case of hydrothorax as a complication of laparoscopic myomectomy in an otherwise healthy woman. The most likely cause of the patient's hydrothorax was irrigation fluid moving from the peritoneal cavity into the pleural space via defects in the diaphragm. Anaesthesists and surgeons should consider hydrothorax as a potential complication in any patient undergoing laparoscopy.

Adult↗
PubMed1991

Case report: hepatic hydrothorax without ascites.

Pleural effusion due to hepatic cirrhosis and ascites is well known. We describe three patients with right-sided hepatic hydrothorax in the absence of ascites. The formation of pleural fluid in these patients is probably a result of fluid movement from peritoneal to pleural space across diaphragmatic defects before ascites can form. The differential diagnosis of a right-sided transudative pleural effusion in a patient with chronic liver disease with or without ascites includes congestive left ventricular failure and nephrotic syndrome. These diseases are usually ruled out with standard clinical tests. Patients with hepatic hydrothorax should be treated with fluid restriction and diuretics. Patients with severe symptoms due to refractory hepatic hydrothorax might benefit from pleural sclerosis and surgical closure of diaphragmatic defects.

Adult↗
PubMed2003

Low complement levels and opsonic activity in hepatic hydrothorax: its relationship with spontaneous bacterial empyema.

GOALS: To analyze the pleural fluid factors that might cause spontaneous bacterial empyema (SBEM) in patients with cirrhotic hydrothorax. BACKGROUND: Pathogenic mechanism of SBEM of cirrhotic patients is probably similar to that of spontaneous bacterial peritonitis, but local factors affecting pleural fluid have not been studied. STUDY: Determination of C3, C4, and opsonic activity levels of pleural fluid in a cohort of patients with pleural effusions of different causes. RESULTS: Forty-eight patients had hepatic hydrothorax; 8, heart failure and 45, exudates (9, tuberculosis; 21, malignancies; 10, other). Of the 48 cirrhotic patients, 15 developed SBEM on admission. The pleural fluid of cirrhotic patients showed significantly lower levels of total protein, complement, and opsonic activity than did the fluids of patients with other causes of SBEM. Patients who developed SBEM had lower concentrations of pleural fluid total protein and C3 and had a higher Child-Pugh score than patients who did not develop the infection. CONCLUSION: Cirrhotic patients with hepatic hydrothorax have lower pleural fluid opsonic activity and C3 levels than those found in the pleural fluid of patients with other causes. Patients who develop SBEM have lower levels of pleural fluid C3, pleural fluid total protein, and a higher Child-Pugh score than those who do not develop SBEM.

Ascites↗
PubMed2004

Hepatic hydrothorax: pathophysiology, diagnosis, and management.

Hepatic hydrothorax occurs in approximately 5 to 12% of patients with cirrhosis and portal hypertension. Various therapeutic modalities ranging from dietary and pharmacologic interventions to surgical approaches are available for the management of this condition. Treatment must be individualized based on the patient's response to conservative management as well as the severity of the underlying liver disease. Hepatic hydrothorax may be complicated by spontaneous bacterial empyema, which portends a poor prognosis with a mortality rate of up to 20%. All patients with hepatic hydrothorax should be evaluated for possible liver transplantation.

Chronic Disease↗
PubMed1986

Elevated pleural fluid glucose: a risk for tension hydrothorax.

We have presented a case of tension hydrothorax that developed after hyperosmolar hyperalimentation fluids were infused into the pleural space through a misplaced jugular venous line. The hyperosmolar state of the pleural fluid appears to have played a prominent role in the development of the tension hydrothorax. We believe there is a risk of tension hydrothorax in any clinical situation in which the pleural fluid glucose concentration is significantly higher than the serum concentration.

Adult↗
PubMed2000

Successful treatment of hepatic hydrothorax with octreotide.

Hepatic hydrothorax is a rare complication of cirrhosis. Controlling ascites formation is the goal of therapy. We report the case of an adult patient presenting with alcoholic cirrhosis who developed first a symptomatic hydrothorax, refractory to diuretics and fluid and sodium restriction, and then an hepatorenal syndrome. Treatment consisted of chest tube insertion and 5 days' intravenous infusion of octreotide. Complete clinical and biological data were reviewed. Octreotide administration resulted in an increased urinary outflow and sodium output, concomitant with improved renal function. The patient has been free of symptoms after discharge from hospital for a follow-up period of 5 months. This observation raises interesting issues regarding the possible utility of splanchnic vasoconstrictors, reducing portal hypertension, in the treatment of refractory hepatic hydrothorax.

Drainage↗
PubMed2003

Hepatic hydrothorax.

A hepatic hydrothorax is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. The pleural effusion is derived from ascitic fluid that enters the chest because of the negative pressure within the pleural space via defects in the diaphragm. The peritoneal-to-pleural flow of fluid can be demonstrated by nuclear scanning, even when the ascites is not clinically apparent. The pleural fluid usually has the characteristics of a transudate. However, an occasional patient with hepatic hydrothorax will develop spontaneous bacterial pleuritis manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. Treatment of the hydrothorax is directed at the underlying liver disease but a dyspneic patient can obtain relief from a thoracentesis or paracentesis. When medical therapy fails, liver transplantation is the treatment of choice. Both transjugular intrahepatic portosystemic shunting and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality of these procedures are high because of the fragile nature of the patients.

Humans↗
PubMed2004

Pathogenesis and management of hydrothorax complicating peritoneal dialysis.

PURPOSE OF REVIEW: Hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) appears in approximately 2% of all patients. Recent advances in minimally invasive surgery have revolutionized the treatment strategy of this condition. RECENT FINDINGS: Hydrothorax in CAPD is most commonly secondary to a pleuro-peritoneal communication. Thoracocentesis with biochemical analysis of pleural fluid is the first-line investigation. In uncertain cases, or when there is a clinical need to demonstrate the anatomy of the communication, an imaging approach such as peritoneal scintigraphy is required. Cessation of peritoneal dialysis is indicated if diagnosis of the complication is confirmed. For half of the cases, a conservative approach allows reinstitution of CAPD, presumably because of spontaneous resolution of the leakage. A small-volume exchange is a feasible alternative for children. In patients who failed conservative treatment, video-assisted thoracoscopic pleurodesis or diaphragmatic repair or both allows most of them to continue with CAPD. Chemical pleurodesis is probably indicated for those who failed conservative treatment in centers without video-assisted thoracoscopic support. Currently, only a minority of patients will require open thoracotomy. SUMMARY: Once hydrothorax secondary to pleuro-peritoneal communication is confirmed in CAPD patients, temporary cessation of peritoneal dialysis remains the first-line treatment. Current evidence shows that video-assisted thoracoscopic pleurodesis or repair should be the treatment of choice in patients who failed conservative management.

Humans↗
PubMed2004

Review article: hepatic hydrothorax.

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

Algorithms↗
PubMed1998

Detection of diaphragmatic defect as the cause of severe hepatic hydrothorax with magnetic resonance imaging.

Severe right-sided hepatic hydrothorax occurred in an 83-yr-old Japanese woman with a 7-yr history of cryptogenic liver cirrhosis. Transdiaphragmatic communication was indirectly suggested by rapid migration of dye (indocyanine green) from the peritoneal to the pleural space. Magnetic resonance imaging studies also demonstrated a diaphragmatic defect as a characteristic hypointense jet flow across the diaphragm on both T1- and T2-weighted sagittal scans. Although no firm treatment for hepatic hydrothorax has been established and direct demonstration of diaphragmatic defect with noninvasive imaging is extremely rare, testing for diaphragmatic integrity is meaningful to provide a radical or less invasive treatment. Magnetic resonance imaging, as well as color Doppler ultrasonography, may be useful for the detection of diaphragmatic defects as the cause of hepatic hydrothorax.

Aged↗
PubMed1995

Postnatal resolution of non-chylous primary fetal hydrothorax.

We describe two cases of non-chylous primary fetal hydrothorax not associated with hydrops or associated malformations. Repeated ultrasonographic examinations, to detect development of hydrops or progression of intrapleural effusion, were used to evaluate the need for intrauterine thoracocentesis and to decide the optimal time for delivery. Both infants did well after postnatal evacuation of the intrapleural fluid. Pre- and postnatal investigation to find the pathophysiological mechanism leading to hydrothorax were negative. We conclude, in agreement with previous work, that primary fetal hydrothorax is generally associated with a favourable outcome.

Adult↗
PubMedDate not supplied

Hydrothorax secondary to a perinephric pseudocyst in a cat.

Hydrothorax was identified in a 14-year-old Siamese cat with a pre-existent perinephric pseudocyst. The pleural fluid was classified as a low-protein transudate. Intrapseudocystic scintigraphy confirmed a direct communication between the pseudocyst and the pleural space. The hydrothorax resolved following pseudocystectomy and unilateral nephrectomy, demonstrating that the pseudocyst caused the hydrothorax.

Animals↗