Lee Wei Chee, Ye QinHao Jonathan, Sharma Kiran
General Medicine, Sengkang General Hospital, Singapore, SGP.
Cureus. 2024 Jun 10;16(6):e62058. doi: 10.7759/cureus.62058. eCollection 2024 Jun.
Unilateral exudative pleural effusions have been described as a rare complication of polycystic liver disease. Surgical debridement of the main cyst reduces recurrence of the pleural effusion. We describe the case of an elderly Asian woman with recurrent large right-sided pleural effusion and also a large hepatic cyst under her right hemidiaphragm. She was deemed a poor surgical candidate and was treated with an indwelling pleural catheter (IPC). She was discharged from Sengkang General Hospital with improvement in symptoms. An 88-year-old Asian woman presented twice to Sengkang General Hospital with recurrent right-sided exudative pleural effusion. She had a past medical history of hypertension, type 2 diabetes, hyperlipidemia, ischemic heart disease (left ventricle ejection fraction 55%), atrial fibrillation, and chronic kidney disease stage 3 (estimated glomerular filtration rate 53). She denied any family history of polycystic kidney or liver disease. Computer tomography of her chest, abdomen, and pelvis revealed a large right pleural effusion and also a large hepatic cyst. A pleural catheter was inserted and the fluid analysis was consistent with an exudative effusion. The pleural fluid was sterile to culture for bacteria and mycobacterium. The cytology was negative for malignant cells. The pleural effusion recurred quickly despite repeated large-volume drainage from the pleural catheter. Our patient was not suitable for surgical debridement of the hepatic cyst and eventually received an IPC and was discharged. With the advent of IPC, there has been increasing interest in using IPC in the management of non-malignant pleural effusions. While surgical debridement of hepatic cysts is the preferred treatment option in recurrent pleural effusion associated with polycystic liver disease, IPCs now provide another viable and minimally invasive option for clinicians and patients.
单侧渗出性胸腔积液被描述为多囊肝病的一种罕见并发症。对主要囊肿进行手术清创可减少胸腔积液的复发。我们报告一例老年亚洲女性病例，该患者反复出现右侧大量胸腔积液，且右半膈下有一个大的肝囊肿。她被认为不适合手术，因此接受了留置胸腔导管（IPC）治疗。她从盛港综合医院出院时症状有所改善。一名88岁的亚洲女性因反复出现右侧渗出性胸腔积液两次就诊于盛港综合医院。她既往有高血压、2型糖尿病、高脂血症、缺血性心脏病（左心室射血分数55%）、心房颤动和慢性肾脏病3期（估计肾小球滤过率53）病史。她否认有任何多囊肾或多囊肝病家族史。她的胸部、腹部和骨盆的计算机断层扫描显示有大量右侧胸腔积液以及一个大的肝囊肿。插入了一根胸腔导管，液体分析结果与渗出性积液一致。胸腔积液细菌和分枝杆菌培养无菌。细胞学检查未发现恶性细胞。尽管通过胸腔导管反复大量引流，胸腔积液仍很快复发。我们的患者不适合对肝囊肿进行手术清创，最终接受了IPC治疗并出院。随着IPC的出现，人们越来越关注将其用于非恶性胸腔积液的管理。虽然肝囊肿手术清创是多囊肝病相关复发性胸腔积液的首选治疗方案，但IPC现在为临床医生和患者提供了另一种可行的微创选择。
