pleurodesis hepatic

PURPOSE OF REVIEW: Benign pleural effusions are common and usually managed by treating the underlying disease process. In some patients, these effusions may be refractory to medical management. Indwelling pleural catheters, used extensively for malignant pleural effusions, are increasingly used in benign pleural effusions not responding to medical therapy. This review focuses on current data regarding their safety and effectiveness in effusions due to congestive heart failure, hepatic hydrothorax, end-stage renal disease, and chylothorax...

Hepatic hydrothorax (HH) is an infrequent but debilitating and therapeutically challenging complication of advanced liver cirrhosis. As evidence suggests against chest tube placement in HH, many clinicians are reluctant to place indwelling pleural catheters (IPCs) for non-malignant effusions like HH. We aim to study the efficacy and safety of IPCs as an alternative treatment option in our systematic review. A literature search was conducted using the electronic database engines MEDLINE, PubMed, EMBASE, Ovid, Scopus and Cochrane Library (Cochrane Central Register of Controlled trials and Cochrane Database of Systematic Reviews) from inception to April 2018 to identify published articles and reports addressing outcomes in patients treated for HH with IPCs...

BACKGROUND: The outcome of indwelling pleural catheter (IPC) use in hepatic hydrothorax (HH) is unclear. This study aimed to review the safety and feasibility of the IPC in patients with refractory HH. METHODS: A retrospective multicenter study of patients with HH from January 2010 to December 2016 was performed. Inclusion criteria were refractory HH treated with an IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports, and laboratory values...

Pleural effusions occur in 1.5 million patients yearly and are a common cause of dyspnea. For nonmalignant effusions, initial treatment is directed at the underlying cause, but when effusions become refractory to medical therapy, palliative options are limited. Tunneled pleural catheters (TPCs) are commonly used for palliation of malignant effusions, but many clinicians are reluctant to recommend these devices for palliation of nonmalignant effusions, citing concerns of infection, renal failure, electrolyte disturbances and protein-loss malnutrition...

PURPOSE OF REVIEW: Hepatic hydrothorax is a complication of end-stage liver disease that may have significant associated morbidity. Sodium restriction and diuretic therapy are the mainstays of treatment, though up to a quarter of patients will become refractory to this and will require a pleural drainage procedure. Thoracentesis, transjugular intrahepatic portosystemic shunt, and chemical pleurodesis all have variable success rates and associated complications in the management of hepatic hydrothorax...

A 68-year-old man with alcoholic liver cirrhosis and portal hypertension was admitted due to ascites. Bilateral severe hepatic hydrothorax did not resolve despite sodium restriction, and diuretic treatment, requiring repeated thoracentesis for relief of dyspnoea. Curative options, as transjugular intrahepatic portosystemic shunt and liver transplantation were both contraindicated. An attempt of pleurodesis was ineffective. Bilateral insertion of tunnelled pleural catheter allowed symptom control and home discharge...

BACKGROUND: Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of HH. AIM: To evaluate the effectiveness and safety of pleurodesis for HH in a systematic review with meta-analysis. METHODS: All relevant papers were searched on the EMBASE and PubMed databases. As for the data from the eligible case reports, the continuous data were expressed as the median (range) and the categorical data were expressed as the frequency (percentage)...

RATIONALE: Hepatic hydrothorax is a complication of cirrhosis in which hydrostatic imbalances result in fluid accumulation within the pleural space. Although uncommon, this may cause significant morbidity, resulting in dyspnea requiring repeated pleural drainage procedures. Liver transplantation is curative, but it is rarely immediately available to qualified patients, presenting the clinical challenge of managing recurrent pleural effusions. Indwelling tunneled pleural catheters (ITPCs) have been used successfully to palliate dyspnea associated with recurrent malignant pleural effusions...

Recently, various video-assisted thoracoscopic surgical techniques have been reported with occasional success in treating hepatic hydrothorax (HH). In 2 patients with refractory HH, we applied a combination of four therapeutic modalities as a single procedure named as a "four-step approach": (1) pneumoperitoneum for localization of diaphragmatic defects, (2) thoracoscopic pleurodesis, (3) postoperative continuous positive airway pressure, and (4) drainage of ascites for abdominal decompression. The treatment was successful in both patients, without recurrence during the follow-up period of 24 and 3 months, respectively...

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Chemical pleurodesis is one of the therapeutic tools to control hepatic hydrothorax. Tetracycline and derivatives have been widely accepted as an effective and safe treatment for the purpose, but availability is the big concern. Tigecycline is an antibiotic derivative of tetracycline, which has demonstrated to be an effective pleurodesing agent in animal models. The aim of the study was to document two successful tigecycline pleurodesis in patients with decompensated liver cirrhosis, who were not candidates for liver transplantation...

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...

INTRODUCTION: This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion. METHODS: We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013...

A known complication of peritoneal dialysis is the movement of dialysate into the pleural space, termed hydrothorax. Peritoneal dialysis-related hydrothorax is almost uniformly right-sided and represents one of many presentations of the porous diaphragm syndrome. In addition to diaphragm porosity, the inherent intestinal circulation, lower hydrostatic pressure in the right upper quadrant and liver capsule may contribute to this right-sided predominance. Similar right-sided presentations have been described in Meigs syndrome, bilious effusions with gastric or duodenal perforations, hepatic hydrothorax and nephrotic syndrome-related chylothorax...

Pleural Disease PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Tunneled pleural catheters (TPCs) have been established to be safe and effective in the management of recurrent symptomatic pleural effusions. Obstruction of the TPC is rare; however, when obstructed the catheter fails to achieve its primary goal. Management of TPC obstruction is not well described. We aim to determine if the use intracatheter fibrinolytic therapy is safe and effective in restoring catheter function...

Hepatic hydrothorax is a complication of liver cirrhosis. Several invasive therapeutic approaches have been performed such as thoracentesis, video-assisted thoracic surgery and repair of the diaphragmatic defects with debatable results. Medical thoracoscopy is a minimally invasive and effective technique with challenging applications that has not been thoroughly used in the treatment of hepatic hydrothorax. We hereby present the case of a hepatic hydrothorax complicated by thoracic empyema in a 38-year-old patient with alcoholic cirrhosis that was treated with medical thoracoscopy and talc pleurodesis...

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)...

BACKGROUND: Pleural effusions may result from intra-abdominal processes and sometimes present with dramatic clinical consequences. We present 2 cases of recurrent hydrothorax requiring surgical repair of diaphragmatic defects and describe when surgery may be the best treatment modality. PATIENT 1: : A 63-year-old man with end-stage renal disease requiring peritoneal dialysis presented with dyspnea on exertion that progressed to cardiac arrest. He was found to have a tension hydrothorax that was initially stabilized with thoracentesis and tube thoracostomy...

Hepatic hydrothorax (HH) is an uncommon complication in patients with end-stage liver disease. Only 5% to 10% of patients with end-stage liver disease develop HH, which may result in dyspnea, hypoxia, and infection, and portends a poor prognosis. The most likely explanation for development is passage of fluid from the peritoneal space to the pleural space due to small diaphragmatic defects. Initial management consists of diuretics with dietary sodium restriction and thoracentesis, and a transjugular intrahepatic portosystemic shunt may ultimately be required...

Malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax are clinical entities requiring pleurodesis to avoid the accumulation of liquid and air, respectively. The objectives are to alleviate symptoms (dyspnea, pain and cough), decrease prolonged air leak, avoid recurrence and improve quality of life. Chemical pleurodesis utilizes chemical irritants. The most common of these is "talc" because of its efficiency and its success in lowering the rate of recurrence. Its main indication is in the palliative treatment of malignant pleural effusion...