Ascites is a common manifestation of portal hypertension in patients with cirrhosis.
Approximately 5% of patients with cirrhosis may develop a pleural effusion. This is
usually right sided. In the absence of cardiac or lung disease, the presence of a
pleural effusion in a cirrhotic patient is known as hepatic hydrothorax. Small volumes
of fluid within the pleura may be associated with significant respiratory symptoms
which require the clinician to rapidly remove the fluid. The development of hepatic
hydrothorax is secondary to passage of ascites from the abdomen to the pleural space
via defects in the diaphragm. Once the diagnosis of hepatic hydrothorax is established
with certainty, medical therapy with salt restriction and diuretics is initiated.
When these measures are ineffective the patient has refractory hepatic hydrothorax.
Based on current studies, transjugular intrahepatic portal systemic shunts appear
to be the most effective form of treatment for these patients.
ascites - hepatic hydrothorax - therapeutic thoracentesis - intraperitoneal Tc99m sulfur colloid - trans-jugular intrahepatic portal systemic shunt (TIPS) - peritoneovenous
shunt
