Hepatology International

, Volume 3, Issue 4, pp 582–586 | Cite as

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Original Article

Abstract

Purpose

Case reports and small case series have reported a high rate of complications associated with chest tube placement for hepatic hydrothorax. We describe the in-hospital and 3-month outcomes of patients who have had this procedure.

Methods

A retrospective medical record review was performed of all patients admitted to a tertiary care center over a 10-year period with a chest tube placed for hepatic hydrothorax. Demographic data and outcomes were collected and analyzed.

Results

Seventeen patients were identified; 12 were taking diuretics and 8 were taking multiple diuretics at the time of admission. MELD score was 14 (range = 7–34). During hospitalization, 16 had at least 1 and 12 had more than 1 complications. The most common complications were acute kidney injury (n = 11), pneumothorax (n = 7), and empyema (n = 5). Two patients died during the index admission and four others within 3 months of that admission. Six of seven patients who received TIPS survived.

Conclusions

Chest tube insertion for hepatic hydrothorax carries significant morbidity and mortality, with questionable benefit.

Keywords

Hepatic hydrothorax Chest tube Cirrhosis Ascites Acute kidney injury 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

ICD

International classification of diseases

INR

International normalized ratio

MELD

Model for end-stage liver disease

TIPS

Transjugular intrahepatic portosystemic shunt

References

  1. 1.
    Cardenas A, Kelleher T, Chopra S. Review article: hepatic hydrothorax. Aliment Pharmacol Ther 2004;20:271–279CrossRefPubMedGoogle Scholar
  2. 2.
    Milanez de Campos JR, Andrade Filho LO, de Campos Werebe E, et al. Hepatic hydrothorax. Semin Respir Crit Care Med 2001;22:665–674CrossRefPubMedGoogle Scholar
  3. 3.
    Kinasewitz GT, Keddissi JI. Hepatic hydrothorax. Curr Opin Pulm Med 2003;9:261–265CrossRefPubMedGoogle Scholar
  4. 4.
    Lazaridis KN, Frank JW, Krowka MJ, Kamath PS. Hepatic hydrothorax: pathogenesis, diagnosis, and management. Am J Med 1999;107:262–267CrossRefPubMedGoogle Scholar
  5. 5.
    Xiol X, Tremosa G, Castellote J, Gornals J, Lama C, Lopez C, et al. Liver transplantation in patients with hepatic hydrothorax. Transpl Int 2005;18:672–675CrossRefPubMedGoogle Scholar
  6. 6.
    Feldman M, Friedman LS, Brandt LJ. Sleisenger & Fordtran’s gastrointestinal and liver disease. 8th ed. Philadelphia: W.B. Saunders; 2006Google Scholar
  7. 7.
    Liu LU, Haddadin HA, Bodian CA, Sigal SH, Korman JD, Bodenheimer HC Jr, et al. Outcome analysis of cirrhotic patients undergoing chest tube placement. Chest 2004;126:142–148CrossRefPubMedGoogle Scholar
  8. 8.
    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;13:529–534CrossRefPubMedGoogle Scholar
  9. 9.
    Jeffries MA, Kazanjian S, Wilson M, Punch J, Fontana RJ. Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax. Liver Transpl 1998;4:416–423CrossRefGoogle Scholar
  10. 10.
    Cerfolio RJ, Bryant AS. Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax. Ann Thorac Surg 2006;82:457–459CrossRefPubMedGoogle Scholar
  11. 11.
    Ferrante D, Arguedas MR, Cerfolio RJ, Collins BG, van Leeuwen DJ. Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax. Am J Gastroenterol 2002;97:3172–3175CrossRefPubMedGoogle Scholar
  12. 12.
    Milanez de Campos JR, Filho LO, de Campos Werebe E, Setter H Jr, Fernandez A, Filomeno LT, et al. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax. Chest 2000;118:13–17CrossRefPubMedGoogle Scholar
  13. 13.
    Borchardt J, Smirnov A, Metchnik L, Malnick S. Lesson of the week: treating hepatic hydrothorax. BMJ 2003;326:751–2CrossRefPubMedGoogle Scholar
  14. 14.
    Runyon BA, Greenblatt M, Ming RH. Hepatic hydrothorax is a relative contraindication to chest tube insertion. Am J Gastroenterol 1986;81:566–567PubMedGoogle Scholar
  15. 15.
    Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc 2006;3:75–80CrossRefPubMedGoogle Scholar
  16. 16.
    Ibrisim D, Cakaloglu Y, Akyuz F, Karadag A, Ozdil S, Besisik F, et al. Treatment of hepatic hydrothorax with terlipressin in a cirrhotic patient. Scand J Gastroenterol 2006;41:862–865CrossRefPubMedGoogle Scholar
  17. 17.
    Pfammatter R, Quattropani C, Reichen J, Goke B, Wagner AC. Treatment of hepatic hydrothorax and reduction of chest tube output with octreotide. Eur J Gastroenterol Hepatol 2001;13:977–980CrossRefPubMedGoogle Scholar
  18. 18.
    Chen A, Ho YS, Tu YC, Tang HS, Cheng TC. Diaphragmatic defect as a cause of massive hydrothorax in cirrhosis of liver. J Clin Gastroenterol 1988;10:663–666PubMedCrossRefGoogle Scholar
  19. 19.
    Wong F. Hepatorenal syndrome: current management. Curr Gastroenterol Rep 2008;10:22–29CrossRefPubMedGoogle Scholar
  20. 20.
    Karwa R, Woodis CB. Midodrine and octreotide in treatment of cirrhosis-related hemodynamic complications. Ann Pharmacother 2009;43:692–699CrossRefPubMedGoogle Scholar
  21. 21.
    Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, et al. The management of ascites in cirrhosis: report on the Consensus Conference of the International Ascites Club. Hepatology 2003;38:258–266CrossRefPubMedGoogle Scholar
  22. 22.
    Wilputte JY, Goffette P, Zech F, Godoy-Gepert A, Geubel A. The outcome after transjugular intrahepatic portosystemic shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction: a long-term study in 28 patients. Acta Gastroenterol Belg 2007;70:6–10PubMedGoogle Scholar
  23. 23.
    Spencer EB, Cohen DT, Darcy MD. Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax. J Vasc Interv Radiol 2002;13:385–390CrossRefPubMedGoogle Scholar
  24. 24.
    Gordon FD, Anastopoulos HT, Crenshaw W, Gilchrist B, McEniff N, Falchuk KR, et al. The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology 1997;25:1366–1369CrossRefPubMedGoogle Scholar
  25. 25.
    Andrade RJ, Martin-Palanca A, Fraile JM, Alcantara R, Carmona C, Medina MC, et al. Transjugular intrahepatic portosystemic shunt for the management of hepatic hydrothorax in the absence of ascites. J Clin Gastroenterol 1996;22:305–307CrossRefPubMedGoogle Scholar
  26. 26.
    Conklin LD, Estrera AL, Weiner MA, Reardon PR, Reardon MJ. Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax. Ann Thorac Surg 2000;69:609–611CrossRefPubMedGoogle Scholar
  27. 27.
    Dumortier J, Lepretre J, Scalone O, Boillot O, Scoazec JY, Delafosse B, et al. Successful treatment of hepatic hydrothorax with octreotide. Eur J Gastroenterol Hepatol 2000;12:817–820CrossRefPubMedGoogle Scholar
  28. 28.
    Haskal ZJ, Zuckerman J. Resolution of hepatic hydrothorax after transjugular intrahepatic portosystemic shunt (TIPS) placement. Chest 1994;106:1293–1295CrossRefPubMedGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2009

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Division of GastroenterologyUniversity of Michigan Health SystemAnn ArborUSA

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