HEPATIC HYDROTHORAX WITHOUT ASCITES: A DIAGNOSTIC AND MANAGEMENT CHALLENGE
DOI:
https://doi.org/10.55519/JAMC-S4-12094Keywords:
hepatic hydrothorax, chronic liver disease, pleural effusion, ascitesAbstract
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.References
Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine (Baltimore) 2014;93(3):135–42.
Cárdenas A, Kelleher T, Chopra S. Hepatic hydrothorax. Aliment Pharmacol Ther 2004;20(3):271–9.
Osman KT, Abdelfattah AM, Mahmood SK, Elkhabiry L, Gordon FD, Qamar AA. Refractory hepatic hydrothorax is an independent predictor of mortality when compared to refractory ascites. Dig Dis Sci 2022;67(10):4929–38.
Roussos A, Philippou N, Mantzaris GJ, Gourgouliannis KI. Hepatic hydrothorax: pathophysiology diagnosis and management. J Gastroenterol Hepatol 2007;22(9):1388–93.
Kim JS, Kim CW, Nam HS, Cho JH, Ryu JS, Lee HL. Hepatic hydrothorax without ascites as the first sign of liver cirrhosis. Respirol Case Rep 2016;4(1):16–8.
Abba AA, Laajam MA, Zargar SA. Spontaneous neutrocytic hepatic hydrothorax without ascites. Respir Med 1996;90(10):631–4.
Rubinstein D, McInnes IE, Dudley FJ. Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management. Gastroenterology 1985;88(1):188–91.
Luh SP, Chen CY. Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases. J Zhejiang Univ Sci B 2009;10:547–51.
Banini BA, Alwatari Y, Stovall M, Ogden N, Gershman E, Shah RD, et al. Multidisciplinary management of hepatic hydrothorax in 2020: an evidence‐based review and guidance. Hepatology 2020;72(5):1851–63.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Maria Malick, Wajeeha Shahid, Anum Latif, Zarafshan Zubair, Syeda Moazzama Zaidi
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
