Neurocritical Care Fellowship, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
Pulmonary and Critical Care Division, Internal Medicine Department, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, Lebanon.
Lung. 2019 Aug;197(4):399-405. doi: 10.1007/s00408-019-00231-6. Epub 2019 May 25.
Hepatic hydrothorax is a challenging complication of cirrhosis related to portal hypertension with an incidence of 5-11% and occurs most commonly in patients with decompensated disease. Diagnosis is made through thoracentesis after excluding other causes of transudative effusions. It presents with dyspnea on exertion and it is most commonly right sided. Pathophysiology is mainly related to the direct passage of fluid from the peritoneal cavity through diaphragmatic defects. In this updated literature review, we summarize the diagnosis, clinical presentation, epidemiology and pathophysiology of hepatic hydrothorax, then we discuss a common complication of hepatic hydrothorax, spontaneous bacterial pleuritis, and how to diagnose and treat this condition. Finally, we elaborate all treatment options including chest tube drainage, pleurodesis, surgical intervention, Transjugular Intrahepatic Portosystemic Shunt and the most recent evidence on indwelling pleural catheters, discussing the available data and concluding with management recommendations.
肝性胸水是一种与门静脉高压相关的肝硬化的挑战性并发症，其发病率为 5-11%，最常发生于失代偿期疾病患者。诊断通过排除其他渗出性胸腔积液的原因后进行胸腔穿刺。其表现为活动时呼吸困难，最常见于右侧。发病机制主要与液体从腹腔通过膈缺陷直接传递有关。在本次文献更新综述中，我们总结了肝性胸水的诊断、临床表现、流行病学和发病机制，然后讨论了肝性胸水的一种常见并发症，即自发性细菌性胸膜炎，以及如何诊断和治疗这种情况。最后，我们详细阐述了所有的治疗选择，包括胸腔引流管、胸膜固定术、手术干预、经颈静脉肝内门体分流术和留置胸腔导管的最新证据，讨论了现有数据，并得出管理建议。
