Management of refractory hepatic hydrothorax.

Abstract:

PURPOSE OF REVIEW:Treatment of hepatic hydrothorax is challenging because of its rapid symptomatic recurrence. This review will focus on potential therapeutic approaches to hepatic hydrothorax. RECENT FINDINGS:Hepatic hydrothorax is refractory to salt restriction and diuretics in approximately 25% of cases. Primary management options for these patients include serial thoracenteses, transjugular intrahepatic portosystemic shunt (TIPS) placement, and insertion of an indwelling pleural catheter (IPC). Response rate to TIPS, being the first choice whenever possible, is about 80%. IPC is emerging as a feasible alternative in patients who require frequent therapeutic thoracenteses, particularly if TIPS is contraindicated. Pleurodesis is not advocated because of the low likelihood of a pleural symphysis owing to the rapid re-accumulation of pleural fluid. The only cure for hepatic hydrothorax, a defined complication of end-stage liver disease, is liver transplantation. SUMMARY:No single treatment option for refractory hepatic hydrothorax is ideal. However, in patients with contraindications to or who are awaiting liver transplantation, TIPS seems the most beneficial therapy, whereas IPC promises to be an alternative second-line consideration.

journal_name

Curr Opin Pulm Med

authors

Porcel JM

doi

10.1097/MCP.0000000000000058

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

352-7

issue

4

eissn

1070-5287

issn

1531-6971

journal_volume

20

pub_type

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