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refractory transudate pleural effusion

Maged H Hussein, Musthafa Chalikandy Peedikayil, Zamir Ahmed Zamir, Abdulrahman Alfadda
Hepatic hydrothorax (HH) is a transudative pleural effusion that complicates advanced liver cirrhosis. Cases refractory to medical treatment in the form of salt restriction and diuretics are labeled refractory hepatic hydrothorax (RHH) and may require transjugular intrahepatic portosystemic shunts (TIPSS) or even liver transplantation. Renal impairment is common in advanced liver disease, worsens its prognosis, and makes the management of HH more challenging. Successful antiviral therapy reduces some of the complications of cirrhosis secondary to hepatitis C virus (HCV) infection...
April 2018: Annals of Thoracic Medicine
Masato Habuka, Toru Ito, Yuta Yoshizawa, Koji Matsuo, Shuichi Murakami, Daisuke Kondo, Hiroshi Kanazawa, Ichiei Narita
Refractory pleural effusion can be a life-threatening complication in patients receiving maintenance hemodialysis. We report successful treatment of refractory pleural effusion using a Denver® pleuroperitoneal shunt in one such patient. A 54-year-old Japanese man, who had previously undergone left nephrectomy, was admitted urgently to our department because of a high C-reactive protein (CRP) level, right pleural effusion, and right renal abscess. Because antibiotics proved ineffective and his general state was deteriorating, he underwent emergency insertion of a thoracic drainage tube and nephrectomy, and hemodialysis was started...
March 23, 2018: CEN Case Reports
Lucía Ferreiro, José M Porcel, Luis Valdés
Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates. The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself...
June 19, 2017: Archivos de Bronconeumología
Vinaya S Karkhanis, Jyotsna M Joshi
A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions...
2012: Open Access Emergency Medicine: OAEM
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
Sayyed Gholam Reza Mortazavimoghaddam, H R Riasi
Here we report a 22-year old woman with massive and bilateral transudative effusion succeeded by pulmonary edema and brain edema and death. Investigations for systemic disorders were negative. Exacerbation of dyspnea after intravenous fluid infusion was a main problem. As effusion was refractory to medical treatment, the patient was referred for surgical pleurodesis and bilateral surgical pleurodesis were done separately. Postsurgically, dyspnea exacerbation occurred after each common cold infection. Vertigo and high intracranial pressure were also a problem postsurgically...
2012: Case Reports in Pulmonology
Marc Noppen
Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases. Other common indications include diagnosis and management of recurrent or refractory benign exudates or transudates, pleural based tumors and pleural thickening, selected cases of pleural empyema, and recurrent spontaneous primary and secondary pneumothorax...
December 2010: Seminars in Respiratory and Critical Care Medicine
Toshikazu Araoka, Hiroya Takeoka, Keisuke Nishioka, Masaki Ikeda, Makiko Kondo, Azusa Hoshina, Seiji Kishi, Makoto Araki, Rokuro Mimura, Taichi Murakami, Akira Mima, Kojiro Nagai, Hideharu Abe, Toshio Doi
INTRODUCTION: Refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation is rarely reported and has a poor prognosis in general (a median survival of 1.6 months). Moreover, the optimum treatment for this condition is still undecided. This is the first report on the successful use of vincristine, adriamycin and dexamethasone chemotherapy for refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis without cardiac decompensation...
2010: Journal of Medical Case Reports
Wei-Lin Chen, Chi-Li Chung, Shih-Hsin Hsiao, Shi-Chuan Chang
BACKGROUND AND OBJECTIVE: Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions. METHODS: Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied...
August 2010: Respirology: Official Journal of the Asian Pacific Society of Respirology
Pascale Mercky, Lama Sakr, Laurent Heyries, Xavier Lagrange, José Sahel, Hervé Dutau
Refractory hepatic hydrothorax poses a challenging therapeutic dilemma, as treatment options are limited. Herein, we describe the case of a 48-year-old lady with advanced cirrhosis and recurrent transudative pleural effusion despite a sodium-restricted diet, optimal diuretic therapy and transjugular intrahepatic portosystemic shunt. Given the patient's platelet and coagulation disorders, thoracoscopic pleurodesis was deemed unsafe. Instead, a tunneled pleural catheter (PleurX®) was inserted under local anesthesia...
2010: Respiration; International Review of Thoracic Diseases
Chi-Li Chung, Ching-Yu Yeh, Joen-Rong Sheu, Yi-Chu Chen, Shi-Chuan Chang
BACKGROUND: Repeated thoracenteses is indicated in patients with refractory, symptomatic transudative effusions. However, their effect on cytokines and fibrinolytic activity in pleural transudates remains unclear. METHODS: Twenty-one patients with symptomatic, large amount of free-flowing transudative effusions caused by heart failure were studied. Thoracentesis with drainage of 500 mL of pleural fluid per day was done for 3 consecutive days (days 1 to 3). Pleural fluid characteristics, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-8, vascular endothelial growth factor (VEGF), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured during each tap...
December 2007: American Journal of the Medical Sciences
S Bozkurt, J Stein, G Teuber
Hepatic hydrothorax is a rare complication of portal hypertension secondary to liver cirrhosis affecting approximately 5-10% of cirrhotic patients with ascites. Hepatic hydrothorax results from an accumulation of fluid migrating through a diaphragmatic defect from the abdominal cavity into the pleural cavities. The effusion of hepatic hydrothorax is typically transudative whereas the effusion of spontaneous bacterial empyema (SBEM) is exudative. The clinical management of hepatic hydrothorax is equivalent to that of ascites...
December 2005: Zeitschrift Für Gastroenterologie
J R Milanez de Campos, L O Andrade Filho, E de Campos Werebe, F L Pandulo, L T Filomeno, F B Jatene
Hepatic hydrothorax (HH) is an uncommon manifestation of cirrhosis with ascites. Pleural effusions form when ascitic fluid moves through diaphragmatic defects that have been opened by increased peritoneal pressure. The diagnosis is established clinically by finding a serous transudate and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces. In end-stage liver disease, the management of hepatic hydrothorax is problematic and often does not respond to medical therapy...
December 2001: Seminars in Respiratory and Critical Care Medicine
A Cardenas, T Kelleher, S Chopra
Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2-3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5-8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1-2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia...
August 1, 2004: Alimentary Pharmacology & Therapeutics
J-S Lee, C-H Song, J-H Lim, K-S Lee, H-J Kim, J-K Park, T-H Paik, S-S Jung, E-K Jo
OBJECTIVE: The role of monocyte chemotactic protein (MCP)-1 in human pulmonary and pleural tuberculosis (TB) was assessed by examining its production in clinical samples from patients with active pulmonary TB and tuberculous pleurisy (TBP). METHODS: Serum was obtained from 26 active pulmonary TB patients [14 early TB (E-TB), and 12 chronic refractory TB (CR-TB)] and 15 healthy tuberculin reactors (HTRs). The monocytes and peripheral blood mononuclear cells (PBMCs) were separated and stimulated with purified protein derivatives (PPD) or the 30-kDa antigen of Mycobacterium tuberculosis...
June 2003: Inflammation Research: Official Journal of the European Histamine Research Society ... [et Al.]
Natsuo Yamamoto, Yoshiaki Noda, Yoshihiro Miyashita
A 51-year-old woman suffering from dyspnoea and refractory bilateral pleural effusions is discussed. The effusion was characterized as a transudate and cardiac decompensation and renal insufficiency were initially suspected. Diuretic agents were not effective and the patient required bilateral chest water-sealed drainage tubes for 4 months, after exclusion of neoplastic infiltration, collagen disease and other cardiac disorders. On echocardiogram, cardiac function and other findings were almost normal, except for shortening of deceleration time in transmitral flow velocity...
December 2002: Respirology: Official Journal of the Asian Pacific Society of Respirology
W Nolte, H R Figulla, B Ringe, J Wiltfang, H Münke, H Hartmann, J Pausch, G Ramadori
HISTORY AND CLINICAL FINDINGS: A 55-year-old woman with known primary biliary cirrhosis (PBC) was hospitalized because of increasing dyspnoea. A year before she had for the first time experienced a right-sided pleural effusion which had to be drained every 4 weeks. Physical examination revealed dullness on percussion and greatly decreased breath sounds on auscultation over the entire right thorax. In addition there were signs of moderate ascites and leg oedema. INVESTIGATIONS: Chest radiograph showed a homogeneous shadowing of the right thorax without mediastinal shift...
October 17, 1997: Deutsche Medizinische Wochenschrift
K G Chetty
A transudative pleural effusion develops when the systemic factors influencing the formation or absorption of the pleural fluid are altered. The pleural surfaces are not involved by the primary pathologic process. The diagnosis of transudative effusion is simple to establish by examining the characteristics of the pleural fluid. Transudates have all of the following three characteristics: The ratio of the pleural fluid to the serum protein is less than 0.5. The ratio of the pleural fluid to the serum LDH is less than 0...
March 1985: Clinics in Chest Medicine
C Y Hsu, S T Gong
Myxedema causes functional derangement of various organs. However, it is rarely presented by pleural effusion. A 71-year-old man who had received radiotherapy for his nasal malignancy and left mandibular tumor developed bilateral, massive, refractory pleural effusions and respiratory embarrassment with several episodes of apnea in spite of treatment with diuretics, antibiotics, antituberculous agents, adrenal corticosteroid hormone and therapeutic thoracenteses. Definitive diagnosis was delayed until 6 months after admission...
June 1990: Journal of the Formosan Medical Association, Taiwan Yi Zhi
C M Kirsch, D W Chui, G G Yenokida, W A Jensen, P B Bascom
Pleural effusion due to hepatic cirrhosis and ascites is well known. We describe three patients with right-sided hepatic hydrothorax in the absence of ascites. The formation of pleural fluid in these patients is probably a result of fluid movement from peritoneal to pleural space across diaphragmatic defects before ascites can form. The differential diagnosis of a right-sided transudative pleural effusion in a patient with chronic liver disease with or without ascites includes congestive left ventricular failure and nephrotic syndrome...
August 1991: American Journal of the Medical Sciences
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