A Rare Presentation of Hepatic Hydrothorax in a Patient with Alcohol induced Liver Cirrhosis

Ganesh Kasinathan^1, and Naganathan Pillai²

¹Department of Internal Medicine, Segamat Hospital, KM 6 Jalan Genuang, 85000 Segamat, Johor, Malaysia

²Department of Internal Medicine, Monash University Malaysia, Bandar Sunway, Malaysia

Cite this paper

Ganesh Kasinathan and Naganathan Pillai. A Rare Presentation of Hepatic Hydrothorax in a Patient with Alcohol induced Liver Cirrhosis. American Journal of Medical Case Reports. 2017; 5(4):104-106. doi: 10.12691/AJMCR-5-4-7

Abstract

Hepatic hydrothorax is defined as significant pleural effusion greater than 500 ml in a patient with liver cirrhosis without any underlying pulmonary, cardiac and pleural disease. This case report describes a 47 year old Indian gentleman who was diagnosed as alcohol induced liver cirrhosis, Child-Turcotte-Pugh score B, with gross ascites. He presented with recurrent right sided pleural effusion. Pleural fluid analysis revealed transudative pleural effusion. A diagnosis of hepatic hydrothorax was made after excluding other causes of pleural effusion. He did not respond to medical therapy and sodium restriction. His recurrent pleural effusion was treated with tube thoracostomy and chemical talc pleurodesis. He was referred to the tertiary hepatology unit for transjugular intrahepatic portosystemic shunt (TIPSS) and liver transplantation. Hepatic hydrothorax should always be suspected in a patient who presents with liver cirrhosis with portal hypertension and transudative pleural effusion.

Keywords

hepatic hydrothorax, cirrhosis, thoracostomy, transplantation, portal hypertension

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Karen LK, Cardenas A. Hepatic hydrothorax. Semin Respir Crit Care Med. 2012; 33: 3-10.
[2]	Kinasewitz GT, Keddissi JI. Hepatic hydrothorax. Curr Opin Pulm Med. 2003; 9: 261-5.
[3]	Esteve M, Xiol X, Fernadez F, Gonzalez F, Baliellas C: Treatment and outcome of hydrothorax in liver cirrhosis. J Clin Nutr Gastroenterol. 1986; 1: 139-144.
[4]	Singh A, Bajwa A, Shujaat A. Evidence based review of the management of hepatic hydrothorax. Respiration 2013; 86: 155-173.
[5]	Zenda T, Miyamoto S, Murata S, Mabuchi H. Detection of diaphragmatic defect as the cause of severe hepatic hydrothorax with magnetic resonance imaging. Am J Gastroenterol. 1998; 93: 2288.
[6]	Siddappa PK, Kar P. Hepatic Hydrothorax. Tropical Gastroenterology 2009; 30(3):135-141.
[7]	Foschi F, Piscaglia F, Pompili M, Corbelli C, Marano G. Real-Time Contrast-Enhanced Ultrasound - a New Simple Tool for Detection of Peritoneal-Pleural Communications in Hepatic Hydrothorax. Ultraschall Med. 2008 Aug; 22: 18726840.
[8]	Huang PM, Chang YL, Yang CY, Lee YC. The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding. J Thorac Cardiovasc Surg. 2005; 130: 141-145.
[9]	Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77: 507-513.
[10]	Siegerstetter V, Deibert P, Ochs A, Olschewski M, Blum HE, Rossle M. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol.. 2001; 13: 529-34.
[11]	Falchuk KR, Jacoby I, Colucci WS, Rybak ME. Tetracycline-induced pleural symphysis for recurrent hydrothorax complicating cirrhosis.A new approach to treatment. Gastroenterology. 1977; 72: 319.
[12]	Temes RT, Davis MS, Follis FM, Pett SB Jr, Wernly JA. Video thoracoscopic treatment of hepatic hydrothorax. Ann Thorac Surg. 1997; 64: 1468-9.
[13]	Mouroux J, Perrin C, Venissac N, et al. Management of pleural effusion of cirrhotic origin. Chest 1996; 109:1093.