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Cause and Management

W. Michael Alberts, MD; Allen J. Salem, MD; David A. Solomon, MD; Gregory Boyce, MD

Arch Intern Med. 1991;151(12):2383-2388.

Abstract
Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. A large effusion (hepatic hydrothorax) occasionally appears during the course of the disease. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic cirrhosis. Although the exact mechanism is somewhat controversial, it appears that the ascitic fluid is transported directly into the pleural space. A therapeutic thoracentesis, usually accompanied by a paracentesis, may be necessary to relieve acute symptoms. Long-term management, however, centers around eliminating or reducing the formation of ascites. When this is not successful, tube thoracostomy followed by chemical pleurodesis, primary repair of diaphragmatic defects with pleural sclerosis, or peritoneovenous shunting in conjunction with chemical pleurodesis may be attempted. These interventions may or may not be successful. Management of hepatic hydrothorax remains a clinical challenge.

(Arch Intern Med. 1991;151:2383-2388)

Author Affiliations
From the Divisions of Pulmonary, Critical Care, and Occupational Medicine (Drs Alberts, Salem, and Solomon) and Digestive Diseases and Nutrition (Dr Boyce), Department of Internal Medicine, University of South Florida College of Medicine, Tampa.

Footnotes
Accepted for publication May 29, 1991.

Reprint requests to Division of Pulmonary, Critical Care, and Occupational Medicine, 13000 Bruce B. Downs Blvd (111c), Tampa, FL 33612 (Dr Alberts).

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