Research Article | Open Access
Volume 2024 - 2 | Article ID 250 | https://dx.doi.org/10.51521/IJGHE.2024.1208
Academic Editor: John Bose
Aamir Shafi1*, Abdul Ahad Wani2, Tahir Ashraf3, Mir Nousheen4
1,2,3,4Departmentof General Medicine SKIMS MCH Srinagar Jammu and Kashmir India
*Corresponding Author: Aamir Shafi, Registrar Department of General medicine SKIMS MCH Srinagar Jammu and Kashmir India
Citation: Aamir Shafi*, Abdul Ahad Wani, Tahir Ashraf, Mir Nousheen (2024) Recurrent Hepatic Hydrothorax in the absence of Ascites in Liver Cirrhosis – A Challenging Condition to Diagnose and Treat: Case and Review of Literature. Int J Gastroenterol Hepatol Endosc, 2(2);1-4.
Copyright: © 2024, Aamir Shafi, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
ABSTRACT
Hepatic hydrothorax is a rare manifestation of chronic liver disease occurring in patients with advanced cirrhosis, portal hypertension and ascites. Hepatic hydrothorax is the excessive (>500 ml) accumulation of transudative fluid in the pleural cavity in patients with decompensated liver cirrhosis in the absence of cardiopulmonary, kidney and pleural diseases. We describe a case of liver cirrhosis who presented with rapidly accumulating right pleural effusion and on evaluation was found to have a transudate. There was no ascites on clinical examination or medical imaging. On thorough investigation for cardiac pulmonary and renal disease as well as malignancy the cause of effusion could not be ascertained. Finally, a diagnosis of hepatic hydrothorax was made based on existing liver cirrhosis and features of portal hypertension (esophageal varices). Hepatic hydrothorax in the absence of ascites is very rare but known entity and is believed to occur due to high absorptive capacity of peritoneum which surpasses the secretory rate. Presence of hepatic hydrothorax portends a poor prognosis and is associated with increased mortality. Treatment involves restricting salt, water intake & use of diuretics. Therapeutic thoracentesis is required in cases of respiratory depression. In resistant cases TIPS or an indwelling pleural catheter is placed and patients manage symptoms through intermittent drainage of pleural fluid. Definitive treatment is orthoptic liver transplantation.
KEYWORDS: Hepatic
hydrothorax, liver cirrhosis, pleural effusion.
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