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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pleural effusion due to hepatic cirrhosis and ascites is well known, but hepatic hydrothorax in the absence of ascites is a rare complication. We report a case of liver cirrhosis due to hepatitis C virus with a large and recurring pleural effusion that had an apparent abdominal source in the absence of ascites. We review the characteristics and treatment for hepatic hydrothorax in the absence of ascites.
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PMID:Hepatic hydrothorax in the absence of ascites. 971 35

Hepatic hydrothorax is a relatively infrequent but potentially serious complication of cirrhosis resulting from the accumulation of ascitic fluid in the chest cavity. Medical management is initially directed at controlling ascites formation, but invasive therapeutic procedures may be required if symptoms persist. The aim of this study was to report on the long-term efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) placement to reduce portal hypertension in 12 consecutive subjects with refractory hepatic hydrothorax. Most subjects had evidence of advanced cirrhosis of varying causes (Child-Pugh class A, 1; B, 5; C, 6). Mean subject age was 54 years, and subjects were followed up for a mean of 173 days (range, 7-926 days). The portosystemic pressure gradient after TIPS was reduced to <12 mmHg in all cases. Periprocedural morbidity was noted in 2 subjects, and 30-day survival after TIPS placement was 75%. Overall, 58% of subjects experienced either a complete or partial response following TIPS placement. Subject response did not correlate with age, baseline creatinine clearance, or Child-Pugh score. Cumulative subject survival was 42%, and 4 of the 5 long-term survivors required eventual liver transplantation. Subject age >65 years was associated with early mortality after TIPS placement, but this trend was not statistically significant. All 4 subjects undergoing liver transplantation required perioperative pleural fluid drainage, but only 1 subject has experienced recurrent effusion. We conclude that TIPS may be a safe and effective temporizing treatment for carefully selected patients with refractory hepatic hydrothorax. However, patient survival is limited after TIPS and is primarily determined by availability of liver transplantation.
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PMID:Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax. 972 80

A pressure-overload model in the rat by banding the pulmonary trunk (PT) was developed to investigate alterations in gene expression in left- and right-ventricular compartments during the transition from compensated right-ventricular (RV) hypertrophy to right heart failure. Right heart failure in rat is characterized by liver cirrhosis, hydrothorax and ascites. The diameter of constriction was found to determine the time course of heart failure development. Only the RV free wall and the right atrium increased in weight, without a difference between compensated and failing RV. An increase in circulating ANP revealed a hypertrophic response of the myocardium, while increased circulating ammonia levels discriminated between compensated hypertrophy and failure. As parameters for stress, fibrosis and Ca2+-handling, changes in the pattern and level of the mRNAs encoding atrial natriuretic peptide (ANP), collagenIIIalpha1, and sarcoplasmic endoplasmic reticular calcium ATPase 2 (SERCA2), phospholamban (PLB) and calsequestrin (CSQ) were studied by Northern blot and in situ hybridization analyses. Pulmonary trunk banding resulted in an induction of ANP mRNA, a moderate increase in collagenIII alpha1 mRNA and a decrease in SERCA2 and PLB mRNA levels in both the left and right ventricles, but changes were most pronounced in the myocardium surrounding the RV cavity. Increased ammonia blood levels are a promising prognostic marker to detect the development of right heart failure.
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PMID:Changing patterns of gene expression in the pulmonary trunk-banded rat heart. 976 42

Severe right-sided hepatic hydrothorax occurred in an 83-yr-old Japanese woman with a 7-yr history of cryptogenic liver cirrhosis. Transdiaphragmatic communication was indirectly suggested by rapid migration of dye (indocyanine green) from the peritoneal to the pleural space. Magnetic resonance imaging studies also demonstrated a diaphragmatic defect as a characteristic hypointense jet flow across the diaphragm on both T1- and T2-weighted sagittal scans. Although no firm treatment for hepatic hydrothorax has been established and direct demonstration of diaphragmatic defect with noninvasive imaging is extremely rare, testing for diaphragmatic integrity is meaningful to provide a radical or less invasive treatment. Magnetic resonance imaging, as well as color Doppler ultrasonography, may be useful for the detection of diaphragmatic defects as the cause of hepatic hydrothorax.
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PMID:Detection of diaphragmatic defect as the cause of severe hepatic hydrothorax with magnetic resonance imaging. 982 Apr 18

Hepatic Hydrothorax is a well known complication in patients with cirrhosis and secondary ascites. It is unusual in the absence of ascites, with few cases reported in the literature. We describe a patient with Hepatic Hydrothorax without ascites and review the literature.
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PMID:[Hepatic hydrothorax without ascites: presentation of a case and review of the literature]. 984 31

Hepatic hydrothorax is defined as a pleural effusion in a patient with cirrhosis of the liver and no cardiopulmonary disease. The estimated prevalence of this often debilitating complication in patients with liver cirrhosis is 4% to 10%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. As a result patients are at increased risk of respiratory infection. Initial management consists of sodium restriction, diuretics, and thoracentesis. A transjugular intrahepatic portosystemic shunt may be required. Because most patients with hepatic hydrothorax have end-stage liver disease, a liver transplant should be considered if these options fail.
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PMID:Hepatic hydrothorax: pathogenesis, diagnosis, and management. 1049 20

Hydrothorax has long been recognised as a complication of cirrhosis, but it is seen in only a few patients, mostly on the right side. We report an unusual case of massive left-sided hydrothorax complicating cirrhosis with ascites, where pleuro-peritoneal communication was demonstrated on the left side by radionuclide scanning.
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PMID:Left-sided hepatic hydrothorax with ascites. 1066 38

Hepatopulmonary syndrome is the most widely recognized of the processes associated with end-stage liver disease. Chronic liver dysfunction is associated with pulmonary manifestations due to alterations in the production or clearance of circulating cytokines and other mediators. Hepatopulmonary syndrome results in hypoxemia due to pulmonary vasodilatation with significant arteriovenous shunting and ventilation-perfusion mismatch. Hepatic hydrothorax may develop in patients with cirrhosis and ascites. Rarely, pulmonary hypertension occurs in the setting of portal hypertension. A second group of disorders may primarily affect the lungs and liver (the hepatopulmonary axis). Among these are the congenital conditions alpha(1)-antitrypsin deficiency and cystic fibrosis. Autoimmune liver disease may be associated with lymphocytic interstitial pneumonitis, fibrosing alveolitis, intrapulmonary granulomas, and bronchiolitis obliterans with organizing pneumonia. Sarcoidosis affects the lung and liver in up to 70% of patients. Medications such as amiodarone can result in a characteristic radiologic appearance of pulmonary and hepatic toxic effects. Knowledge of these associations will assist the radiologist in forming a meaningful differential diagnosis and may influence treatment decisions.
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PMID:Diseases of the hepatopulmonary axis. 1083 22

Hepatic hydrothorax is a rare complication of cirrhosis. Controlling ascites formation is the goal of therapy. We report the case of an adult patient presenting with alcoholic cirrhosis who developed first a symptomatic hydrothorax, refractory to diuretics and fluid and sodium restriction, and then an hepatorenal syndrome. Treatment consisted of chest tube insertion and 5 days' intravenous infusion of octreotide. Complete clinical and biological data were reviewed. Octreotide administration resulted in an increased urinary outflow and sodium output, concomitant with improved renal function. The patient has been free of symptoms after discharge from hospital for a follow-up period of 5 months. This observation raises interesting issues regarding the possible utility of splanchnic vasoconstrictors, reducing portal hypertension, in the treatment of refractory hepatic hydrothorax.
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PMID:Successful treatment of hepatic hydrothorax with octreotide. 1092 13

During the 13 years since its introduction into clinical practice, transjugular intrahepatic portosystemic shunt (TIPS) has become widely accepted worldwide as a percutaneous, interventional procedure for treating complications of portal hypertension. An experienced, skillful team, however, is necessary to ensure the high technical success of TIPS and to avoid its potential procedural complications. Presently, TIPS is used mainly for treatment of acute or recurrent hemorrhage from gastroesophageal varices refractory to endoscopic therapy. Randomized studies have shown that it is more effective than endoscopic treatment for preventing rebleeding; however, it is associated with a higher incidence of encephalopathy. Both treatments produce comparable survival rates. TIPS is also effective in the treatment of hepatogenic ascites and hydrothorax and hepatorenal syndrome. In comparison with surgical shunts, TIPS is a significantly less invasive procedure that can be done in poor surgical candidates with advanced cirrhosis. The high rate of shunt obstructions seen with TIPS mandates close surveillance and maintenance, rendering TIPS a multistage procedure. This is a major disadvantage of TIPS compared to surgery. Presently, both TIPS and surgical shunts have their place in the treatment of gastroesophageal variceal hemorrhage unresponsive to endoscopic therapy. TIPS is most suited for class B and C patients, particularly those who are candidates for liver transplantation. Surgical shunts should be considered for patients with well preserved liver function. Large, randomized controlled studies should be done to compare these treatment methods. Animal experimental and early clinical studies using covered stents (stent-grafts) are promising for the prevention of shunt obstructions and thus converting TIPS from a multistage to a one-stage procedure.
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PMID:Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. 1134 89


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