Hydrothorax hepatic J94.8

Transsudative pleural effusions in patients with liver cirrhosis and/or portal hypertension with exclusion of primary heart or lung disease (Gerbes AL et al. 2011).

About 4-10% of patients with advanced liver cirrhosis develop a hydrothorax.

Pathophysiologically, the hydrothorax is based on the same mechanisms as ascites (Cardenas A et al. 2004). In most patients with hydrothorax, diaphragmatic lesions can be detected microscopically and macroscopically [Malagari K et al. 2005]. The currently favoured hypothesis on pathogenesis therefore assumes a transdiaphragmatic passage of the fluid from the peritoneal to the pleural space either via diaphragmatic defects or via lymphatic vessels.

Cirrhosis of the liver, dyspnoea, non-productive cough with pleural pain and fatigue as a result of hypoxaemia. Pleural effusion: In larger studies (n= 1038 patients), a pleural effusion could be detected in 4.7% of cirrhosis patients by CT. Re. > left, less frequently bilaterally (18% of cases.). (Malagari K et al. 2005).

X-rays and chest x-ray; sonography; both in case of initial diagnosis and in case of follow-up, a diagnostic pleural puncture with determination of the cell number, with cell differentiation and protein concentration should be performed. The first puncture should be performed after sonographic control.

Other complications of cirrhosis must be excluded by differential diagnosis. These include:

• hepatopulmonary syndrome
• Porto-pulmonary hypertension
• non-hepatic diseases such as heart failure, tuberculosis, bronchial carcinoma or a parapneumonic pleural effusion.

The treatment of clinically relevant hepatic hydrothorax does not differ from the standard therapy for ascites (Kiafar C et al. 2008).

If ascites is present -therapeutic, abdominal paracentesis; if symptoms persist, therapeutic thoracocentesis. The volume of the drained pleural puncture should not exceed 1.5-2l/puncture; volume substitution is not necessary.

Protracted thoracic drainages should be avoided due to increased renal and septic complications. If a chest tube is necessary, an intravenous album (6-8g/l pleural effusion) is recommended.

1. Cardenas A et al (2004) Management of ascites and hepatic hydrothorax. Best Pract Res Clin Gastroenterol 21: 55-75
2. Gerbes AL et al (2011) S3 Guideline "Ascites, spontaneous bacterial peritonitis, hepatorenal syndrome". Z Gastroenterol 49: 749-779
3. Halank M et al (2010) Pulmonary complications of liver cirrhosis: hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax. Internist 51 (Suppl 1): 255- 263
4. Kinasewitz GT et al.(2003) Hepatic hydrothorax. Curr Opin Pulm Med 9: 261-265
5. Lieberman FL et al (1966) Pathogenesisandtreatment of hydrothorax complicating cirrhosis with ascites. Ann Internal Med 64: 341-351
6. Malagari K et al (2005) Cirrhosis-related intrathoracic disease. Imaging features in 1038 patients. Hepatogastroenterology 52: 558-562
7. Kiafar C et al (2008) Hepatic hydrothorax: current concepts of pathophysiology and treatment options. Ann Hepatol 7: 313-320