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transudate effusion hepatic

Yong Lv, Guohong Han, Daiming Fan
Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the development of HH remains incompletely understood, the most acceptable explanation is that the pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm due to the raised abdominal pressure and the negative pressure within the pleural space. Patients with HH can be asymptomatic or present with pulmonary symptoms such as shortness of breath, cough, hypoxemia, or respiratory failure associated with large pleural effusions...
January 2018: Annals of Hepatology
J Brad Case, Sarah E Boston, Erin P Porter, Beau B Toskich
CASE DESCRIPTION A 17-month-old neutered female Labrador Retriever with a 3- to 4-month history of abdominal distention was referred for evaluation and treatment. CLINICAL FINDINGS Evaluation of a peritoneal fluid specimen collected by the referring veterinarian indicated a pure transudate. At admission, transabdominal ultrasonography revealed microhepatica, dilation of the intrahepatic and mesenteric vasculature, peritoneal effusion, and multiple aberrant blood vessels. A large, high-flow hepatic arteriovenous malformation (HAVM) with secondary portal hypertension, peritoneal effusion, multiple acquired portosystemic shunts, and microhepatica was evident on CT angiography...
October 1, 2017: Journal of the American Veterinary Medical Association
Madhan Nellaiyappan, Anastasios Kapetanos
A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia, and 4 mo of exertional dyspnea. He was noted to be tachypneic and hypoxic. He had a massive right sided pleural effusion with leftward mediastinal shift and gross ascites, with a tense, fluid-filled, umbilical hernia. Emergent paracentesis with drain placement and a large volume thoracentesis were performed. Despite improvement in dyspnea and drainage of 15 L of ascitic fluid, the massive transudative pleural effusion remained largely unchanged...
May 8, 2017: World Journal of Hepatology
Jung Soo Kim, Cheol-Woo Kim, Hae-Seong Nam, Jae Hwa Cho, Jeong-Seon Ryu, Hong Lyeol Lee
A 60-year-old woman without a history of liver diseases, but with a history of regular alcohol consumption, presented with a right-sided transudative pleural effusion. Neither parenchymal lung lesion nor pleural thickening was seen on a chest computed tomography. On abdominal ultrasonography, the liver size and contour were normal, and ascites was not noted. Despite performing imaging and laboratory studies, we could not find a cause of the pleural effusion. Thus, due to her history of regular alcohol consumption, we decided to measure liver stiffness using a transient elastography (Fibroscan(®), Echosens(TM), Paris, France), which showed a value of 35...
March 2016: Respirology Case Reports
Sachin Kumar, Shiv Kumar Sarin
Hepatic hydrothorax (HH) is an infrequent but a well-known complication of portal hypertension in patients with end-stage liver disease. The estimated prevalence of HH is around 4-6 % in cirrhotics. Thoracentesis and pleural fluid analysis is a must for establishing the diagnosis of this transudative effusion in the absence of primary cardiopulmonary disease. Management strategies include sodium restriction, diuretics, thoracentesis, transjugular intrahepatic portosystemic shunt, pleurodesis, and video assisted thoracic surgery in selected patients...
March 2013: Hepatology International
Jae Hee Woo, Rack Kyung Chung, Hee Jung Baik, Youn Jin Kim
We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation, which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotracheal tube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosed with an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmatic incision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusion towards the ipsilateral lung during the remaining operation period...
April 2015: Korean Journal of Anesthesiology
L J Tong, S L Bennett, D J Thompson, S L Adsett, R E Shiel
CASE REPORT: A 9-year-old female intact Cocker Spaniel was presented with a history of acute-onset dyspnoea and abdominal distension of 3 days' duration. Ultrasonography revealed pleural, peritoneal and pericardial effusions. Abdominal fluid analysis was consistent with a modified transudate. Echocardiography revealed a large, hypoechoic space-occupying mass within the right atrium. The dog was euthanased and the postmortem examination showed a solid, 40 × 35 × 20 mm broad-based mass arising from the right atrial wall and occluding approximately 90% of the right atrial lumen...
March 2015: Australian Veterinary Journal
Mohammad Alhaji, Ruxana T Sadikot
Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis without primary cardiac, pulmonary or pleural disease. It is a rare but important cause of unilateral-pleural effusion. The prevalence of this complication is 5-10% of the total number of patients with advanced stages of cirrhosis. In most cases (85%), the effusion is right-sided; however, in 13% of cases it can be left-sided and bilateral in 2% of the cases. We present a case of left-sided hepatic hydrothorax in the absence of ascites in a patient with primary biliary cirrhosis...
October 2013: Expert Review of Respiratory Medicine
Victor I Machicao, Maya Balakrishnan, Michael B Fallon
The association of chronic liver disease with respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease have been characterized: hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax (HH). The development of portal hypertension is fundamental in the pathogenesis of each of these disorders. HPS is the most common condition, found in 5%-30% of cirrhosis patients, manifested by abnormal oxygenation due to the development of intrapulmonary vascular dilatations...
April 2014: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Kittiya Sukcharoen, Steven Dixon, Kamarjit Mangat, Andrew Stanton
A previously well 66-year-old woman presented with a recurrent transudative right-sided pleural effusion. A nodular liver with coarse echotexture was demonstrated on ultrasound and subsequent MRI found hepatocellular carcinoma. In the absence of cardiopulmonary disease and significant protein uria, the recurrent pleural effusion was presumed to be hepatic hydrothorax despite the absence of ascites or other clinical features of chronic liver disease. The patient is currently awaiting liver transplantation.
September 11, 2013: BMJ Case Reports
José M Porcel, Estela Mas, Josep M Reñé, Silvia Bielsa
BACKGROUND AND OBJECTIVE: To describe the clinical characteristics, the most effective treatment and survival of cirrhotic patients with hepatic hydrothorax (HH). PATIENTS AND METHOD: Descriptive and retrospective analysis of a cohort of consecutive patients with HH undergoing a diagnostic thoracentesis. The biochemical and radiological features of the pleural effusion, its control with different therapies and the factors affecting survival were evaluated, among other parameters...
December 7, 2013: Medicina Clínica
W-I Choi, D Qama, M Y Lee, K Y Kwon
OBJECTIVE: To examine the properties of mesothelial cells by measuring pleural cancer antigen 125 (CA-125) levels in different types of benign and malignant pleural effusions. DESIGN: In this retrospective study, pleural fluid was collected from 326 patients; pleural CA-125 levels were measured using radioimmunoassay. Patients were classified into five groups according to the aetiology of pleural effusions: I) tuberculosis, II) malignant, III) pyogenic, IV) congestive heart failure, and V) hepatic hydrothorax...
May 2013: International Journal of Tuberculosis and Lung Disease
José M Porcel
PURPOSE OF REVIEW: Light's criteria combine three dichotomous tests into a decision rule that is considered positive if any one of the tests is positive. This strategy clearly maximizes sensitivity, although at the expense of specificity. Although Light's criteria identify 98% of pleural exudates, they misclassify about 25% of transudates as exudates. The way to overcome this limitation is discussed in this review. RECENT FINDINGS: Traditionally, measurement of the protein gradient between the serum and pleural fluid has been recommended to decrease the misclassification rate of Light's criteria...
July 2013: Current Opinion in Pulmonary Medicine
Rajesh Thomas, Y C Gary Lee
Benign pleural effusions are twice as common as malignant effusions and have diverse causes and manifestations, which often makes them a diagnostic challenge. Differentiating effusions as a transudate or exudate is the first, and often helpful, step in directing investigations for diagnosis and management. Congestive heart failure and hepatic hydrothorax are the commonest causes for a transudative effusion. Commonly exudative effusions are caused by infections or may be secondary to pulmonary embolism, drugs, collagen vascular diseases, or may follow cardiac surgery...
February 2013: Thoracic Surgery Clinics
Karen L Krok, Andrés Cárdenas
Hepatic hydrothorax is defined as a transudative pleural effusion, usually greater than 500 mL, in patients with portal hypertension without any other underlying primary cardiopulmonary cause. It develops most likely because of diaphragmatic defects that allow for passage of fluid from the peritoneal space to the pleural space. Because of the mechanical constraints of the thoracic cavity, this complication of portal hypertension can be challenging to treat because patients will become symptomatic when as little as 500 mL of fluid is present in the pleural space...
February 2012: Seminars in Respiratory and Critical Care Medicine
Silvia Bielsa, José M Porcel, José Castellote, Estela Mas, Aureli Esquerda, Richard W Light
BACKGROUND AND OBJECTIVE: Pleural transudates are most commonly due to heart failure (HF) or hepatic hydrothorax (HH), but a number of these effusions are misclassified as exudates by standard (Light's) criteria. The aim of this study was to determine the prevalence of mislabelled transudates and to establish simple alternative parameters to correctly identify them. METHODS: We retrospectively analysed the pleural fluid and serum protein, lactate dehydrogenase and albumin concentrations from 364 cardiac effusions and 102 HH...
May 2012: Respirology: Official Journal of the Asian Pacific Society of Respirology
Puncho Gurung, Mark Goldblatt, John T Huggins, Peter Doelken, Paul J Nietert, Steven A Sahn
BACKGROUND: There are limited published data defining complete pleural fluid analysis, echocardiographic characteristics, or the presence or absence of ascites on sonographic or CT imaging in patients with hepatic hydrothorax. METHODS: We reviewed pleural fluid analysis and radiographic, sonographic, and echocardiographic findings in 41 consecutive patients with hepatic hydrothorax referred to the Pleural Procedure Service for thoracentesis. RESULTS: Ascites was detected on sonographic or CT imaging in 38 of 39 patients (97%)...
August 2011: Chest
Felipe C A Marinho, Francisco S Vargas, José Fabri, Milena M P Acencio, Eduardo H Genofre, Leila Antonangelo, Roberta K B Sales, Lisete R Teixeira
BACKGROUND AND OBJECTIVE: Light's criteria are frequently used to evaluate the exudative or transudative nature of pleural effusions. However, misclassification resulting from the use of Light's criteria has been reported, especially in the setting of diuretic use in patients with heart failure (HF). The objective of this study was to evaluate the utility of B-type natriuretic peptide (BNP) measurements as a diagnostic tool for determining the cardiac aetiology of pleural effusions. METHODS: Patients with pleural effusions attributable to HF (n = 34), hepatic hydrothorax (n = 10), pleural effusions due to cancer (n = 21) and pleural effusions due to tuberculosis (n = 12) were studied...
April 2011: Respirology: Official Journal of the Asian Pacific Society of Respirology
Rosa Cremades, Antonio Galiana, Juan Carlos Rodriguez, Ana Santos, Pilar Lopez, Montserrat Ruiz, Eduardo Garcia-Pachon, Gloria Royo
BACKGROUND: Bacterial DNA due to bacterial translocation has been identified in noninfectious ascitic fluid samples. OBJECTIVE: This study investigated the possible presence of bacterial DNA in the pleural fluid of patients with pleural effusions of noninfectious origin, using a highly sensitive PCR-based method. METHODS: Pleural fluid samples from 175 patients (average age ± SD: 69 ± 14 years) with noninfectious pleural effusion (62 transudates, 113 exudates) were analyzed...
2011: Respiration; International Review of Thoracic Diseases
Lawand Qaradaghi, V Yildirim Imren, Emrah Ereren, Naim Boran Tumer
We presented a case of hemothorax secondary to inferior vena cava (IVC) aneurysm. A 47-year-old woman was presented to our hospital with nausea, vomiting, and right superior abdominal pain. There was pleural effusion on the right side of the posteroanterior chest x-ray for which a thoracentesis was performed and serohemorrhagic fluid was determined. Biochemical tests showed a mixed transudate and hemorrhage (hemothorax). Cytology was negative for malignancy. Computed tomography revealed a right-sided pleural effusion and a suprahepatic mass that was neighboring IVC and right atrium...
August 2010: Annals of Vascular Surgery
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