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PubMed2001

Hepatic hydrothorax: a retrospective case study.

PURPOSE: To present the pathophysiology, differential diagnoses, assessment techniques, and treatment options for hepatic hydrothorax. DATA SOURCES: A case study is presented with supporting material from current medical literature. CONCLUSIONS: Hepatic hydrothorax is a pleural effusion caused by the flow of ascitic fluid into the pleural space through an actual defect in the diaphragm. Successful outcomes depend on early detection and timely referral of often-subtle lung involvement. IMPLICATIONS FOR PRACTICE: Although incidence is reported to be as high as 12% in cirrhotic patients, standard medical references attach little importance to pulmonary risks in this population. Hepatic hydrothorax should always be considered in the cirrhotic patient with a pleural effusion.

Diagnosis, Differential↗

PubMed2000

Severe unilateral hydrothorax as the only manifestation of the ovarian hyperstimulation syndrome.

BACKGROUND: Unilateral hydrothorax is rarely the sole manifestation of the ovarian hyperstimulation syndrome (OHSS) and is suggestive of the severity of the disease. CASE: A 35-year-old woman presented with mild dyspnea 2 weeks after ovarian stimulation with hMG and hCG and IVF-ET. Chest X-ray revealed a large pleural effusion on the right side. Three consecutive thoracocenteses were needed to drain a total of 6,800 cm(3) of fluid. Following drainage, the respiratory symptoms disappeared. An uneventful pregnancy is in progress. CONCLUSIONS: Thoracocentesis is safe and efficient for the treatment of hydrothorax and may be repeated as often as necessary. Clinicians should be aware of the possibility of unilateral hydrothorax as the sole symptom of OHSS.

Adult↗

PubMed1983

Massive hydrothorax complicating continuous ambulatory peritoneal dialysis.

2 patients on continuous ambulatory peritoneal dialysis (CAPD) developed massive hydrothorax. Further studies revealed preferential transfer of fluid from peritoneal cavity to pleural space in absence of a direct pleuroperitoneal communication. Hydrothorax resolved in both following a brief interruption in CAPD but recurred in one upon restitution of CAPD. In case of recurrent hydrothorax, pleurodesis or alternate dialytic therapy should be considered.

Adult↗

PubMed2005

Refractory hepatic hydrothorax: successful treatment with octreotide.

We report the case of a patient that developed hepatic hydrothorax as the first complication of liver cirrhosis. Due to the lack of response to diuretics, pleurodesis and TIPS, treatment with octreotide was started with resolution of hydrothorax. To the best of our knowledge, this is the third reported case of refractory hepatic hydrothorax with complete and sustained response to octreotide.

Aged↗

PubMed2002

Systemic amyloidosis involving the diaphragm and acute massive hydrothorax during peritoneal dialysis.

Hydrothorax secondary to trans-diaphragmatic fluid leakage through a peritoneo-pleural communication is an occasional, potentially serious complication of peritoneal dialysis. The etiology of this condition is not clear, being thought to be due either to congenital or acquired diaphragmatic fenestrations or acquired scarcity of muscle fibers in the tendinous part of the diaphragm which are compounded by increased intra-abdominal pressure during the dwell period of peritoneal dialysis. We report a 54-year-old woman who developed irreversible acute renal failure from adjuvant chemotherapy for ovarian cancer previously resected surgically. Three days after the onset of continuous ambulatory peritoneal dialysis, she developed acute respiratory distress associated with a massive right hydrothorax secondary to a peritoneo-pleural communication demonstrated by scintigraphy. At autopsy 2 weeks later, systemic amyloidosis was surprisingly found and histologic examination of the right hemidiaphragm showed the presence of amyloid, among sparse muscle fibers. This is the first case report of a distinct pathological process, i.e. amyloidosis, involving the diaphragm associated with a peritoneo-pleural communication causing massive hydrothorax at the onset of peritoneal dialysis.

Acute Disease↗

PubMed2001

[A "sweet" hydrothorax].

BACKGROUND: Hydrothorax is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). CASE REPORT: A 68-year-old man on CAPD consulted for rapidly progressive dyspnea. An elevated glucose level in the pleural puncture fluid and Tc-99m peritoneoscitigraphy demonstrated pleuroperitoneal communication via Larrey's cleft led to the diagnosis of "sweet" hydrothorax. Resolution was achieved with pleurocentesis and interruption of CAPD. DISCUSSION: Although rare, hydrothorax should be retained as a possible diagnosis in patients who develop dyspnea within the first 2 months after institution of CAPD. Chemistry of the pleural fluid and Tc-99m scintigraphy provide the diagnosis. Conservative treatment by pleural puncture or pleurodesis is indicated. In most cases, CAPD can be resumed without recurrence.

Aged↗

PubMed2002

[Delayed hydrothorax induced by a pericutaneous central venous catheter; report of a case].

We report herein a case of 53-year-old woman who suffered a hydrothorax induced by a central venous catheter which had been placed to facilitate total parenteral nutrition. The central venous catheter was inserted into the superior vena cava through the right subclavian vein. Chest X-ray film after insertion revealed proper position of the tip. She suddenly developed dyspnea and tachycardia due to right-sided hydrothorax 21 days after the insertion of the catheter. Chest X-ray showed massive pleural effusion in the right thorax, and the catheter tip inadvertently turned upward. The continuous mechanical force of the catheter tip against the SVC wall was considered to be the cause of this life-threatening delayed hydrothorax.

Catheterization, Central Venous↗

PubMed2002

[A case of refractory hepatic hydrothorax that was not treated by transjugular intrahepatic portosystemic shunt].

Refractory hepatic hydrothorax has been treated by conservative methods: salt and water restriction, diuretics, thoracentesis, thoracostomy, and pleurodesis. The results, however, havebeen disappointing. Recently, TIPS has emerged as a new method for refractory hepatic hydrothorax, but it may lead to fatal complications. We report a case of refractory hepatic hydrothorax that was not treated by TIPS despite of successful control of ascitest.

Adult↗

PubMed2005

[Clinical observation on treatment of cancerous hydrothorax by aiyishu injection].

OBJECTIVE: To investigate the therapeutic effects of Aiyishu Injection (AYSI) on cancerous hydrothorax, quality of life (QOF), and cellular immune function of patients. METHODS: Sixty late-stage cancer patients accompanied hydrothorax were randomly divided into the experimental group (EG) and the control group (CG), with thirty patients in each group. After thoracenteses being carried out in all patients for draining off hydropsy, to the patients in EG, AYSI was medicated, 50 ml by intrathoracic and another 50 ml by intravenous injection; while to the patients in CG chemotherapeutic agent or interleukin-2 (IL-2) was given. The same treatment, thoracentesis and medication, was repeated 3 days later. After 4 weeks, the volume of pleural effusion was measured with B-mode ultrasound to evaluate the therapeutic effects of AYSI. QOF, body weight and T-lymphocyte subsets were compared between the two groups before and after treatment. RESULTS: The clinical efficacy was significantly higher in EG than that in CG (P < 0.01). Besides, QOF was significantly improved (P < 0.05) and levels of CD3+ , CD4+ , CD4+ /CD8+ in peripheral blood increased in EG after treatment, which were significantly different to those in CG (P < 0.01, P < 0.05). CONCLUSION: AYSI has definite therapeutic effects on cancerous hydrothorax, it could improve QOF and cellular immune function in patients with cancer.

Animals↗

PubMedDate not supplied

[Hydrothorax in absence of ascites: an unusual complication of hepatic cirrhosis with portal hypertension].

AIM: Authors, describing a clinical case of hepatic hydrothorax in absence of ascites, analyse the disease physiopathology and their therapeutic options. PATIENTS AND METHODS: Case report of a mixed aethiology (HCV and alcohol) hepatic cirrhosis, with pleural effusion, without ascites. CONCLUSIONS: Hepatic hydrothorax without ascites is an uncommon complication of cirrhosis with portal hypertension. Treatment could be pharmacological, with diuretics administration, or operating. A simple and cheap method is thoracentesis. If hydrothorax relapses, most effective method is transjugular intrahepatic portosystemic shunt.

Humans↗

PubMed2006

[Hepatic hydrothorax].

Hepatic hydrothorax was diagnosed in four patients with liver cirrhosis, three men aged 65, 41, and 48 and a woman aged 48. They presented with either right-sided or bilateral pleural-fluid accumulations in the absence of cardiopulmonary disease. In the first man with no concurrent ascites, the disorder was missed, resulting in prolonged chest tube drainage, multiple severe complications and death. In the 41-year-old man chest tube drainage was also associated with complications including renal failure and encephalopathy. Pleurodesis was effective in the woman while in the remaining man hepatic hydrothorax was only a temporary, asymptomatic finding. Pleural effusions in cirrhotic patients should be considered and managed as hepatic hydrothorax unless diagnostic studies reveal a different aetiology. Absence of ascites is not uncommon and should not delay the correct diagnosis. The gradient between pleural and serum albumin concentration is typically more than 11 g/l. Prolonged chest tube drainage is dangerous and should be avoided. In cases refractory to salt restriction and diuretic therapy, transjugular introduction of an intrahepatic portosystemic shunt is the treatment of choice. Recently, pleurodesis combined with thoracoscopic repair ofdiaphragmatic defects has been reported as a potentially effective form of therapy.

Adult↗

PubMed1991

Hydrothorax in a PD patient: successful treatment with intrapleural autologous blood instillation.

An 80-year-old female developed massive right hydrothorax at the start of an IPD program. Peritoneal dialysis was interrupted and after complete evacuation of the pleural effusion, 40 ml of the patient's blood was infused into the right pleural cavity. For the first 2 days the patient maintained the Fowler position. Three weeks later, IPD was recommended, but pleural effusion reappeared early on. Infusion of a further 40 ml of the patient's blood was repeated after another pleural evacuation and the dialysis was again stopped for another 3-week period. Subsequently, IPD was restarted with only one-liter exchanges and the patient kept in the Fowler position during the dialysis sessions. After three weeks, standard IPD was started with the patient supine and two-liter exchanges. Hydrothorax did not re-appear and so far (12-month follow-up) no pleural effusion has been noticed. The patient feels well on IPD. Blood instillation was painless and caused one-day fever on the first time only. Pleurodesis achieved with autologous blood is a very safe, simple and effective way of treating hydrothorax in PD patients.

Aged↗

PubMed1991

Surgical correction of hydrothorax from diaphragmatic eventration in children on peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) is frequently used in the pediatric age group for reversible and end-stage renal failure. Most pediatric patients tolerate this therapy with few complications. Approximately 2% of children, however, develop massive unilateral hydrothorax. This major complication usually results in the discontinuation of peritoneal dialysis in all forms and the institution of hemodialysis. Occult diaphragmatic defects account for most adult and pediatric patients who develop this complication. Three pediatric patients receiving CAPD complicated by massive hydrothorax are described. All patients were successfully treated by thoracotomy and repair of the diaphragmatic eventration with an immediate return to CAPD. This is the first report of successful therapy of this kind in children. A review of the cause, diagnosis, and treatment of massive hydrothorax developing during CAPD therapy is presented.

Child, Preschool↗

PubMed1988

Massive hydrothorax in continuous ambulatory peritoneal dialysis: diagnosis, management and review of the literature.

Recurrent massive hydrothorax is an uncommon but serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). Accurate confirmative diagnostic procedures of the pleuroperitoneal communication is lacking and the management remains difficult. We reported three patients who developed massive hydrothorax at different periods after commencement of CAPD treatment (1.5-9 months). These patients underwent different investigatory procedures for demonstrating the pleuroperitoneal communication. We conclude that both technetium 99m-tagged macroaggregated albumin intraperitoneal radionuclide scan and stereoisomeric analysis of lactate in the peritoneal and pleural fluid are safe and reliable procedures to demonstrate the pleuroperitoneal communication. The massive hydrothorax was successfully treated in two patients by pleurodesis induced by intrapleural administration of oxytetracycline combined with 10-days small volume intermittent peritoneal dialysis. The clinical findings of 18 other cases previously reported in the literature are also reviewed.

Adult↗

PubMed1993

[Meigs syndrome with bilateral hydrothorax].

The co-existence of pelvic tumor, hydrothorax and ascites has been known since the last century. The features of this disease were described by Meigs and Cass in 1937; in the same year Roads named it Meigs syndrome. According to the original description this syndrome only included, as pelvic involvement, an ovarian neoplasm; at present it is accepted that hydrothorax and the ascites can also be associated with a uterine tumor, like a fibroma. The existence of either an ovarian or a uterine neoplasm distinguishes the typical Meigs syndrome from a pseudo-Meigs syndrome. The most likely pathogenesis of Meigs syndrome ascribes the formation of the peritoneal and pleural effusion to the filtration of interstitial fluid in the peritoneum through the tumor capsule, and the diffusion to the pleural space, generally at the right side, through the diaphragm lymphatic vessels and the foramen of Bochdalek. Dockerty reported that at least 40% of ovarian tumors had a diameter of more than 6 cm when associated with hydrothorax and ascites. The entity of pleural and peritoneal effusion can be moderate or massive. The effusions generally derive from a transudative process, but they can occasionally contain blood cells. The connection between the pelvic tumor and the effusion is demonstrated by the regression of the latter when the neoplasm is excised. When the pelvic tumor has an ovarian location it derives from the connective tissue of the hilus, it appears during fertile age and has a slow growth, the clinical signs becoming evident in elder age.

Aged↗

PubMed1996

Management of peritoneal dialysis-induced hydrothorax in children.

Continuous ambulatory peritoneal dialysis (CAPD) is a safe and effective treatment for children with end-stage renal failure. Approximately three per cent of patients develop a large hydrothorax as a result of a dialysate leak from the peritoneal cavity through an occult diaphragmatic eventration or attenuation of the pleuroperitoneal membrane. Previously, such patients often discontinued CAPD and were placed on hemodialysis even though the complications, expense, and limitation of activity with hemodialysis are undesirable in children. During the past 15 years, 6 of the 193 children (3%) undergoing CAPD at UCLA Medical Center developed a hydrothorax. Three patients were male and three were female. Four patients were treated surgically with diaphragmatic plication, one was treated by reducing the dialysate volume, and one was switched to hemodialysis in preparation for a renal transplant. Each of the four surgically-treated children was able to return to full-volume peritoneal dialysis and has not experienced recurrence of the hydrothorax. Therefore, diaphragmatic plication permits children to quickly resume full-volume CAPD and avoid hemodialysis.

Child, Preschool↗

PubMed1997

Cardiotocographic and Doppler velocimetric patterns, pre- and post-thoracentesis, in a case of fetal hydrothorax.

Fetal hydrothorax is associated with elevated perinatal mortality. Management of this condition is controversial given that in utero spontaneous resolution has been described. A case of fetal hydrothorax associated with an extralobar lung sequestration that showed pathologic cardiotocographic patterns and abnormal Doppler velocimetry indices in several fetal vascular beds in reported. All pathologic patterns improved after fetal thoracentesis. It can be concluded that monitoring fetal well-being by means of cardiotocography and Doppler velocimetry may help in timing thoracentesis in cases of fetal hydrothorax.

Adult↗

PubMed1992

The natural history of isolated fetal hydrothorax.

We reviewed the prenatal course and outcome of 11 fetuses with isolated unilateral or bilateral hydro thoraces identified between 14 and 34 weeks' gestation, in the absence of invasive fetal intervention. Four of these fetuses died, three in utero and one in the newborn period. Six of seven survivors had resolution of hydrothorax before birth. Eight of the 11 fetuses had unilateral and three bilateral hydrothoraces. Six of the eight fetuses with unilateral hydrothorax survived, whereas one of the three with bilateral hydrothoraces lived. Six of the 11 pregnancies were complicated by polyhydramnios; four of these six fetuses died. One fetus was found to have trisomy 21. It is difficult to draw firm conclusions from the small number of patients in this report because of the wide range of outcomes found for the sonographic variables described. This series shows, however, a tendency to complete resolution of primary unilateral fetal hydrothorax, with good outcome, particularly in second-trimester fetuses without polyhydramnios.

Journal Article↗