This review considers the modern concepts of pathogenesis,diagnostic methods,and treatment principles of hepatic hydrothorax(HH).HH is the excessive(>500 mL)accumulation of transudate in the pleural cavity in patie...This review considers the modern concepts of pathogenesis,diagnostic methods,and treatment principles of hepatic hydrothorax(HH).HH is the excessive(>500 mL)accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases.It causes respiratory failure which aggravates the clinical course of liver cirrhosis,and the emergence of spontaneous bacterial pleural empyema may be the cause of death.The information was collected from the PubM ed database,the Google Scholar retrieval system,the Cochrane reviews,and the reference lists from relevant publications for 1994-2016 using the keywords:"liver cirrhosis","portal hypertension","hepatic hydrothorax","pathogenesis","diagnostics",and"treatment".To limit the scope of this review,only articles dealing with uncomplicated hydrothorax in patients with liver cirrhosis were included.The analysis of the data showed that despite the progress of modern hepatology,the presence of HH is associated with poor prognosis and high mortality.Most patients suffering from it are candidates for orthotopic liver transplantation.In routine clinical practice,stratification of the risk for an adverse outcome and the subsequent determination of individual therapeutic strategies may be the keys to the successful management of the patient’s condition.The development of pathogenetic pharmacotherapy and optimization of minimally invasive treatment will improve the quality of life and increase the survival rate among patients with HH.展开更多
We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence o...We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The preventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.展开更多
AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt(TIPSS) in refractory hepatic hydrothorax(RHH) in a systematic review and cumulative meta-analysis.METHODS:A comprehensive literatu...AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt(TIPSS) in refractory hepatic hydrothorax(RHH) in a systematic review and cumulative meta-analysis.METHODS:A comprehensive literature search was conducted on MEDLINE,EMBASE,and Pub Med covering the period from January 1970 to August 2014.Two authors independently selected and abstracted data from eligible studies.Data were summarized using a random-effects model.Heterogeneity was assessed using the I2 test.RESULTS:Six studies involving a total of 198 patients were included in the analysis.The mean(SD) age of patients was 56(1.8) years.Most patients(56.9%) had Child-Turcott-Pugh class C disease.The mean duration of follow-up was 10 mo(range,5.7-16 mo).Response to TIPSS was complete in 55.8%(95%CI:44.7%-66.9%),partial in 17.6%(95%CI:10.9%-24.2%),and absent in 21.2%(95%CI:14.2%-28.3%).The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mm Hg.The incidence of TIPSS-related encephalopathy was 11.7%(95%CI:6.3%-17.2%),and the 45-d mortality was 17.7%(95%CI:11.34%-24.13%).CONCLUSION:TIPSS is associated with a clinically relevant response in RHH.TIPSS should be considered early in these patients,given its poor prognosis.展开更多
Objective:To report our experience with supracostal percutaneous nephrolithotomy(SC-PNL)and evaluate factors which could predict the risk of hydrothorax following SC-PNL.Methods:We reviewed 347 patients who underwent ...Objective:To report our experience with supracostal percutaneous nephrolithotomy(SC-PNL)and evaluate factors which could predict the risk of hydrothorax following SC-PNL.Methods:We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019.Patients were assessed for demographic characteristics,indication for the supracostal access,level of supracostal access,anatomy of the kidney(normal or malrotated),site of the puncture in relation to the mid-scapular line(medial or lateral),and whether another subcostal tract for stone clearance was required or not.Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access.In addition,a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL.Results:Of the 347 patients with SC-PNL,248(71.5%)underwent a supra-12th rib approach,while the rest needed a supra-11th(n=85;24.5%)or a supra-10th(n=14;4.0%)rib tract.Overall,17(4.9%)patients developed a hydrothorax,while an intercostal-drain was required in seven of these 17 patients for 48 h.None of the patients with a supra-12th rib puncture required an intercostal-drain.More than a third of the patients with a supra-10th puncture developed a hydrothorax(35.7%)and all of them required an intercostal drain.Factors such as anteriorly malrotated kidney(odds ratio[OR]=2.722;95%confidence interval[CI]=1.042-5.617,p=0.03),puncture medial to the mid-scapular line(OR=1.669;CI=0.542-1.578,p=0.03),and an access higher than the supra-12th level(OR=5.265;CI=1.292-9.342,p<0.001)proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis.Conclusion:Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low.Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.展开更多
A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia,and 4 mo of exertional dyspnea.He was noted to be tachypneic and hypoxic.He had a massive right sided pleu...A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia,and 4 mo of exertional dyspnea.He was noted to be tachypneic and hypoxic.He had a massive right sided pleural effusion with leftward mediastinal shift and gross ascites,with a tense,fluid-filled,umbilical hernia.Emergent paracentesis with drain placement and a large volume thoracentesis were performed.Despite improvement in dyspnea and drainage of 15 L of ascitic fluid,the massive transudative pleural effusion remained largely unchanged.He underwent a repeat large volume thoracentesis on hospital day 4.The patient subsequently developed a tension pneumothorax,which resulted in a dramatic reduction in the effusion.A chest tube was placed and serial radiographs demonstrated resolution of the pneumothorax but recurrence of the effusion.The radiographs illustrate the movement of fluid between the peritoneal and pleural cavities.In this case,the mechanism of pleural effusion was confirmed to be a hepatic hydrothorax via an unintended tension pneumothorax.Methods to elucidate a hepatic hydrothorax include Tc99m or indocyanine green injection into the ascitic fluid followed by its demonstration above the diaphragm.The unintended tension pneumothorax in this case additionally demonstrates bi-directional flow across the diaphragm.展开更多
BACKGROUNDHepatic hydrothorax (HH) is an uncommon and difficult-to-manage complicationof cirrhosis with limited treatment options.AIMTo define the clinical outcomes of patients presenting with HH managed withcurrent s...BACKGROUNDHepatic hydrothorax (HH) is an uncommon and difficult-to-manage complicationof cirrhosis with limited treatment options.AIMTo define the clinical outcomes of patients presenting with HH managed withcurrent standards-of-care and to identify factors associated with mortality.METHODSCirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 wereretrospectively identified. HH was defined as pleural effusion in the absence ofcardiopulmonary disease. The primary outcomes were overall and transplant-freesurvival at 12-mo after the index admission. Cox proportional hazards analysiswas used to determine factors associated with the primary outcomes.RESULTSOverall, 84 patients were included (mean age, 58 years) with a mean model forend-stage liver disease score of 29. Management with diuretics alone achievedlong-term resolution of HH in only 12% patients. At least one thoracocentesis wasperformed in 73.8% patients, transjugular intrahepatic portosystemic shuntinsertion in 11.9% patients and 33% patients received liver transplantation within12-mo of index admission. Overall patient survival and transplant-free survival at12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidneyinjury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increasedrisk of mortality.CONCLUSIONCirrhotic patients with HH are a challenging population with a poor 12-mo survival despitecurrent treatments. Current smoking and episodes of AKI are potential modifiable factors affectingsurvival. HH is often refractory of diuretic therapy and transplant assessment should beconsidered in all cases.展开更多
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 con...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.展开更多
BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patientswith end-stage renal disease. PD-related hydrothorax is a rare but seriouscomplication in PD patients, produced by the movement...BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patientswith end-stage renal disease. PD-related hydrothorax is a rare but seriouscomplication in PD patients, produced by the movement of peritoneal dialysatethrough pleuroperitoneal fistulas. In previous reports, patients with hydrothoraxsecondary to PD were usually recommended to discontinue PD and transfer tohemodialysis (HD). Herein, we describe another method of managing thiscomplication—with an adjusted PD prescription and continuous drainage ofpleural effusion, patients could continue PD without recurrence of hydrothorax.CASE SUMMARY In this report, we present the medical records of 2 patients with hydrothoraxsecondary to PD. We recommended intermittent PD with continuous drainage ofpleural effusion. A type 18Ga soft catheter was placed to drain pleural effusion.Ultrasound-guided thoracentesis was performed, and the soft catheter was placedin the pleural cavity for a long period (3 mo and 2 mo, respectively). The pleuralcatheter was removed when no fluid was drained from the pleural cavity. Afterseveral months, pleuroperitoneal fistulas were closed in both patients and PD wascontinued. These patients did not transfer to HD, had no recurrence ofhydrothorax and were still treated with PD after 1 year.CONCLUSION These 2 case reports show that continuous drainage of pleural effusion with an18Ga soft catheter is a useful method for hydrothorax secondary to PD.展开更多
Cell therapy was proposed as a potential treatment intervention for liver cirrhosis recently due to the fact that the therapeutic protocol for primary biliary cirrhosis (PBC)-associated refractory umbilical hernia and...Cell therapy was proposed as a potential treatment intervention for liver cirrhosis recently due to the fact that the therapeutic protocol for primary biliary cirrhosis (PBC)-associated refractory umbilical hernia and hepatic hydrothorax is not well defined currently. We report herein the case of a 58-year-old woman who received routine treatments for PBC, which developed into an incarcerated hernia and uncontrolled hydrothorax. This subject’s condition was significantly improved and maintained stable condition after receiving human umbilical cord blood-derived mononuclear cell (CBMC) transplantation. Consequently, this new strategy may be a potential treatment option for the refractory umbilical hernia and hydrothorax caused by PBC. However, sufficient data from large-scale controlled and double-blinded clinical trials are needed to further confirm the treatment efficacy and longterm safety before this cell transplantation can be used as a regular therapy for liver cirrhosis.展开更多
Background: Hydrothorax, as one of the common complications of malignant tumors, still cannot be sensitively detected in clinical practice, thus requiring a sensitive, specific method for diagnosis. The aim of this s...Background: Hydrothorax, as one of the common complications of malignant tumors, still cannot be sensitively detected in clinical practice, thus requiring a sensitive, specific method for diagnosis. The aim of this study was to analyze the correlation between levels of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) in patients with benign and malignant hydrothorax. Methods: The contents of VEGF in the pleural effusion and serum of the patients with malignant pleural effusion (n = 35) and benign pleural effusion (n = 30) were detected by double antibody sandwich enzyme linked immunosorbent assay. The gene copy number level of EGFR in pleural effusion was detected by fluorescence in situ hybridization (FISH). The points with the highest sensitivity and specificity were selected as the critical values to calculate the diagnostic value of the VEGF in pleural effusion and serum, and EGFR gene copy number in pleural effusion. Results: The contents of VEGF in pleural effusion and serum of patients with malignant hydrothorax were (384.91 ± 120.18), and (129.62 ±46.35) ng/L, respectively, which were significantly higher than those of the patients with benign hydrothorax (207.97 ± 64.04), (63.49 ± 24.58) ng/L (P 〈 0.01 ). The sensitivity and specificity of detecting VEGF in pleural effusion were 80.0% and 96.7% (the boundary value was 297.06 ng/L), respectively for diagnosing benign and malignant hydrothorax. The sensitivity and specificity of serum were 74.3% and 96.7%, respectively (the boundary value was 99.21 ng/L) for diagnosing benign and malignant hydrothorax. The diagnostic efficiencies of EGFR and VEGF in hydrothorax were similar. There was a significant correlation between EGFR and VEGF in hydrothorax (P 〈 0.01 ). Conclusions: VEGF and EGFR play important roles in the formation of pleural effusion. VEGF differed significantly in benign and malignant pleural effusions, which contributed to differential diagnosis results of benign and malignant pleural effusions. It is feasible to detect the gene copy number of the pleural effusion cell mass EGFR by FISH technique. Joint detection can improve the diagnostic sensitivity.展开更多
The prevalence of pleural effusion caused by hepatocirrhosis ranges from 0.4% to 30%. Some patients with hepatic hydrothorax (HH) fail to respond to aggressive medical management such as albumin application, diureti...The prevalence of pleural effusion caused by hepatocirrhosis ranges from 0.4% to 30%. Some patients with hepatic hydrothorax (HH) fail to respond to aggressive medical management such as albumin application, diuretics, and thoracentesis, and remain refractory massive pleural fluid. The repeated suctions to relieve the symptoms such as respiratory distress are associated with significant hyponatremia and hypoalbuminemia caused by the large volumes of fluid loss. Review of the literature has revealed that, to date, no therapy is ideal. This report describes our experiments in treating HH of patients with cirrhosis and ascites by thoracoscopy and talc poudrage, to offer our efforts to approach the pathogenesis of HH and to explore the new therapeutic strategy.展开更多
Background:Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at pre...Background:Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods:Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery(VATS) . Repair of the diaphragmatic defects,or pleurodesis by focal pleurectomy,talc spray,mechanical abrasion,electro-cauterization or injection was administered intraoperatively,and tetracycline intrapleural injection was used postoperatively for patients with prolonged(>7 d) high-output(>300 ml/d) pleural effusion. Results:Out of the 12 patients,8(67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4(33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion:We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.展开更多
文摘This review considers the modern concepts of pathogenesis,diagnostic methods,and treatment principles of hepatic hydrothorax(HH).HH is the excessive(>500 mL)accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases.It causes respiratory failure which aggravates the clinical course of liver cirrhosis,and the emergence of spontaneous bacterial pleural empyema may be the cause of death.The information was collected from the PubM ed database,the Google Scholar retrieval system,the Cochrane reviews,and the reference lists from relevant publications for 1994-2016 using the keywords:"liver cirrhosis","portal hypertension","hepatic hydrothorax","pathogenesis","diagnostics",and"treatment".To limit the scope of this review,only articles dealing with uncomplicated hydrothorax in patients with liver cirrhosis were included.The analysis of the data showed that despite the progress of modern hepatology,the presence of HH is associated with poor prognosis and high mortality.Most patients suffering from it are candidates for orthotopic liver transplantation.In routine clinical practice,stratification of the risk for an adverse outcome and the subsequent determination of individual therapeutic strategies may be the keys to the successful management of the patient’s condition.The development of pathogenetic pharmacotherapy and optimization of minimally invasive treatment will improve the quality of life and increase the survival rate among patients with HH.
文摘We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The preventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.
文摘AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt(TIPSS) in refractory hepatic hydrothorax(RHH) in a systematic review and cumulative meta-analysis.METHODS:A comprehensive literature search was conducted on MEDLINE,EMBASE,and Pub Med covering the period from January 1970 to August 2014.Two authors independently selected and abstracted data from eligible studies.Data were summarized using a random-effects model.Heterogeneity was assessed using the I2 test.RESULTS:Six studies involving a total of 198 patients were included in the analysis.The mean(SD) age of patients was 56(1.8) years.Most patients(56.9%) had Child-Turcott-Pugh class C disease.The mean duration of follow-up was 10 mo(range,5.7-16 mo).Response to TIPSS was complete in 55.8%(95%CI:44.7%-66.9%),partial in 17.6%(95%CI:10.9%-24.2%),and absent in 21.2%(95%CI:14.2%-28.3%).The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mm Hg.The incidence of TIPSS-related encephalopathy was 11.7%(95%CI:6.3%-17.2%),and the 45-d mortality was 17.7%(95%CI:11.34%-24.13%).CONCLUSION:TIPSS is associated with a clinically relevant response in RHH.TIPSS should be considered early in these patients,given its poor prognosis.
文摘Objective:To report our experience with supracostal percutaneous nephrolithotomy(SC-PNL)and evaluate factors which could predict the risk of hydrothorax following SC-PNL.Methods:We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019.Patients were assessed for demographic characteristics,indication for the supracostal access,level of supracostal access,anatomy of the kidney(normal or malrotated),site of the puncture in relation to the mid-scapular line(medial or lateral),and whether another subcostal tract for stone clearance was required or not.Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access.In addition,a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL.Results:Of the 347 patients with SC-PNL,248(71.5%)underwent a supra-12th rib approach,while the rest needed a supra-11th(n=85;24.5%)or a supra-10th(n=14;4.0%)rib tract.Overall,17(4.9%)patients developed a hydrothorax,while an intercostal-drain was required in seven of these 17 patients for 48 h.None of the patients with a supra-12th rib puncture required an intercostal-drain.More than a third of the patients with a supra-10th puncture developed a hydrothorax(35.7%)and all of them required an intercostal drain.Factors such as anteriorly malrotated kidney(odds ratio[OR]=2.722;95%confidence interval[CI]=1.042-5.617,p=0.03),puncture medial to the mid-scapular line(OR=1.669;CI=0.542-1.578,p=0.03),and an access higher than the supra-12th level(OR=5.265;CI=1.292-9.342,p<0.001)proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis.Conclusion:Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low.Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.
文摘A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia,and 4 mo of exertional dyspnea.He was noted to be tachypneic and hypoxic.He had a massive right sided pleural effusion with leftward mediastinal shift and gross ascites,with a tense,fluid-filled,umbilical hernia.Emergent paracentesis with drain placement and a large volume thoracentesis were performed.Despite improvement in dyspnea and drainage of 15 L of ascitic fluid,the massive transudative pleural effusion remained largely unchanged.He underwent a repeat large volume thoracentesis on hospital day 4.The patient subsequently developed a tension pneumothorax,which resulted in a dramatic reduction in the effusion.A chest tube was placed and serial radiographs demonstrated resolution of the pneumothorax but recurrence of the effusion.The radiographs illustrate the movement of fluid between the peritoneal and pleural cavities.In this case,the mechanism of pleural effusion was confirmed to be a hepatic hydrothorax via an unintended tension pneumothorax.Methods to elucidate a hepatic hydrothorax include Tc99m or indocyanine green injection into the ascitic fluid followed by its demonstration above the diaphragm.The unintended tension pneumothorax in this case additionally demonstrates bi-directional flow across the diaphragm.
基金The Human Research Ethics Committee at Monash Health and Austin Health approved the study as a quality assurance activity and the committee provided a waiver for informed consent(RES-19-0000-343Q).
文摘BACKGROUNDHepatic hydrothorax (HH) is an uncommon and difficult-to-manage complicationof cirrhosis with limited treatment options.AIMTo define the clinical outcomes of patients presenting with HH managed withcurrent standards-of-care and to identify factors associated with mortality.METHODSCirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 wereretrospectively identified. HH was defined as pleural effusion in the absence ofcardiopulmonary disease. The primary outcomes were overall and transplant-freesurvival at 12-mo after the index admission. Cox proportional hazards analysiswas used to determine factors associated with the primary outcomes.RESULTSOverall, 84 patients were included (mean age, 58 years) with a mean model forend-stage liver disease score of 29. Management with diuretics alone achievedlong-term resolution of HH in only 12% patients. At least one thoracocentesis wasperformed in 73.8% patients, transjugular intrahepatic portosystemic shuntinsertion in 11.9% patients and 33% patients received liver transplantation within12-mo of index admission. Overall patient survival and transplant-free survival at12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidneyinjury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increasedrisk of mortality.CONCLUSIONCirrhotic patients with HH are a challenging population with a poor 12-mo survival despitecurrent treatments. Current smoking and episodes of AKI are potential modifiable factors affectingsurvival. HH is often refractory of diuretic therapy and transplant assessment should beconsidered in all cases.
文摘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.
文摘BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patientswith end-stage renal disease. PD-related hydrothorax is a rare but seriouscomplication in PD patients, produced by the movement of peritoneal dialysatethrough pleuroperitoneal fistulas. In previous reports, patients with hydrothoraxsecondary to PD were usually recommended to discontinue PD and transfer tohemodialysis (HD). Herein, we describe another method of managing thiscomplication—with an adjusted PD prescription and continuous drainage ofpleural effusion, patients could continue PD without recurrence of hydrothorax.CASE SUMMARY In this report, we present the medical records of 2 patients with hydrothoraxsecondary to PD. We recommended intermittent PD with continuous drainage ofpleural effusion. A type 18Ga soft catheter was placed to drain pleural effusion.Ultrasound-guided thoracentesis was performed, and the soft catheter was placedin the pleural cavity for a long period (3 mo and 2 mo, respectively). The pleuralcatheter was removed when no fluid was drained from the pleural cavity. Afterseveral months, pleuroperitoneal fistulas were closed in both patients and PD wascontinued. These patients did not transfer to HD, had no recurrence ofhydrothorax and were still treated with PD after 1 year.CONCLUSION These 2 case reports show that continuous drainage of pleural effusion with an18Ga soft catheter is a useful method for hydrothorax secondary to PD.
文摘Cell therapy was proposed as a potential treatment intervention for liver cirrhosis recently due to the fact that the therapeutic protocol for primary biliary cirrhosis (PBC)-associated refractory umbilical hernia and hepatic hydrothorax is not well defined currently. We report herein the case of a 58-year-old woman who received routine treatments for PBC, which developed into an incarcerated hernia and uncontrolled hydrothorax. This subject’s condition was significantly improved and maintained stable condition after receiving human umbilical cord blood-derived mononuclear cell (CBMC) transplantation. Consequently, this new strategy may be a potential treatment option for the refractory umbilical hernia and hydrothorax caused by PBC. However, sufficient data from large-scale controlled and double-blinded clinical trials are needed to further confirm the treatment efficacy and longterm safety before this cell transplantation can be used as a regular therapy for liver cirrhosis.
文摘Background: Hydrothorax, as one of the common complications of malignant tumors, still cannot be sensitively detected in clinical practice, thus requiring a sensitive, specific method for diagnosis. The aim of this study was to analyze the correlation between levels of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) in patients with benign and malignant hydrothorax. Methods: The contents of VEGF in the pleural effusion and serum of the patients with malignant pleural effusion (n = 35) and benign pleural effusion (n = 30) were detected by double antibody sandwich enzyme linked immunosorbent assay. The gene copy number level of EGFR in pleural effusion was detected by fluorescence in situ hybridization (FISH). The points with the highest sensitivity and specificity were selected as the critical values to calculate the diagnostic value of the VEGF in pleural effusion and serum, and EGFR gene copy number in pleural effusion. Results: The contents of VEGF in pleural effusion and serum of patients with malignant hydrothorax were (384.91 ± 120.18), and (129.62 ±46.35) ng/L, respectively, which were significantly higher than those of the patients with benign hydrothorax (207.97 ± 64.04), (63.49 ± 24.58) ng/L (P 〈 0.01 ). The sensitivity and specificity of detecting VEGF in pleural effusion were 80.0% and 96.7% (the boundary value was 297.06 ng/L), respectively for diagnosing benign and malignant hydrothorax. The sensitivity and specificity of serum were 74.3% and 96.7%, respectively (the boundary value was 99.21 ng/L) for diagnosing benign and malignant hydrothorax. The diagnostic efficiencies of EGFR and VEGF in hydrothorax were similar. There was a significant correlation between EGFR and VEGF in hydrothorax (P 〈 0.01 ). Conclusions: VEGF and EGFR play important roles in the formation of pleural effusion. VEGF differed significantly in benign and malignant pleural effusions, which contributed to differential diagnosis results of benign and malignant pleural effusions. It is feasible to detect the gene copy number of the pleural effusion cell mass EGFR by FISH technique. Joint detection can improve the diagnostic sensitivity.
文摘The prevalence of pleural effusion caused by hepatocirrhosis ranges from 0.4% to 30%. Some patients with hepatic hydrothorax (HH) fail to respond to aggressive medical management such as albumin application, diuretics, and thoracentesis, and remain refractory massive pleural fluid. The repeated suctions to relieve the symptoms such as respiratory distress are associated with significant hyponatremia and hypoalbuminemia caused by the large volumes of fluid loss. Review of the literature has revealed that, to date, no therapy is ideal. This report describes our experiments in treating HH of patients with cirrhosis and ascites by thoracoscopy and talc poudrage, to offer our efforts to approach the pathogenesis of HH and to explore the new therapeutic strategy.
文摘Background:Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods:Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery(VATS) . Repair of the diaphragmatic defects,or pleurodesis by focal pleurectomy,talc spray,mechanical abrasion,electro-cauterization or injection was administered intraoperatively,and tetracycline intrapleural injection was used postoperatively for patients with prolonged(>7 d) high-output(>300 ml/d) pleural effusion. Results:Out of the 12 patients,8(67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4(33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion:We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.