Hepatic hydrothorax

Hepatic hydrothorax (C.S. Morrow et al., 1958) is evident during the course of liver cirrhosis with ascites in 0.4-12% of cases. The mean frequency is about 6%, although in two-thirds of the cases, a right-sided effusion (with the author s own patients a bilateral effusion) was ascertained. (66) (s. fig. 16.8) Hepatic hydrothorax is a transudate cell count protein concentration <2.5 g/dl, total protein effusion to serum ratio <0.5, LDH effusion to serum ratio <2.3, serum to pleural fluid albumin gradient >1.1 g/dl. (s. also fig. 16.9) (17, 37, 47, 52 - 54, 66)... 

Fig. 16.8 Right-sided hepatic hydrothorax in liver cirrhosis...

Rubinstein, D., Mclnnes, I.E., Dudiey, F.J. Hepatic hydrothorax in the absence of clinical ascites. Diagnosis and management. Gastroenterology 1985 88 188-191... 

Strauss, R.M., Boyer, T.D. Hepatic hydrothorax. Semin. Liver Dis. 

Degawa, M., Hamasaki, K., Yano, K., Kanao, K., Kato, Y., Sakamoto, I., Nakata, K., Eguchi, K. Refractory hepatic hydrothorax treated with transjugular intrahepatic portosystemic shunt. J. Gastroenterol. 1999 34 128-131... 

Therapy includes paracentesis -i- thoracocentesis + i.v. albumin solution, pleural drainage or pleurodesis with talc. Recently, pleurodesis using argon beam coagulation + minocycline hydrochloride has been recommended. In the case of refractory hepatic hydrothorax, TIPS or liver transplantation may be indicated. (53)... 

Ferrante, D., Arguedas, M.R., Cerfolio, R.J., Collins, B.G., van Leeu-wen, D.J. Video-assisted thoracoscopy surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax. Amer. X. Gastroenterol. 2002 97 3172-3175... 

Another feature of vitamin A hepatotoxicity, namely respiratory symptoms caused by hepatic hydrothorax, associated with excessive vitamin A consumption has been reported (49). 

Miksad R, de Ledinghen V, McDougall C, Fiel I, Rosenberg H. Hepatic hydrothorax associated with vitamin a toxicity. J Clin Gastroenterol 2002 34(3) 275-9. 

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