Pleural Interventions in the Management of Hepatic Hydrothorax
Autor: | Christopher R. Gilbert, Lonny Yarmus, Fabien Maldonado, Samira Shojaee, Jed A. Gorden, Najib M. Rahman, Eihab O Bedawi, David Feller-Kopman, Jason Akulian |
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Rok vydání: | 2022 |
Předmět: |
Liver Cirrhosis
Pulmonary and Respiratory Medicine medicine.medical_specialty Thoracentesis medicine.medical_treatment Hydrothorax Thoracostomy Critical Care and Intensive Care Medicine Catheters Indwelling Internal medicine Hypertension Portal medicine Humans Intensive care medicine Pleurodesis Pleural Cavity business.industry Liver Diseases Disease Management Hepatology medicine.disease Pleural Effusion Pulmonology Chest Tubes Video-assisted thoracoscopic surgery Portal hypertension Cardiology and Cardiovascular Medicine business Transjugular intrahepatic portosystemic shunt |
Zdroj: | Chest. 161:276-283 |
ISSN: | 0012-3692 |
Popis: | Hepatic hydrothorax can be present in 5% to 15% of patients with underlying cirrhosis and portal hypertension, often reflecting advanced liver disease. Its impact can be variable, because patients may have small pleural effusions and minimal pulmonary symptoms or massive pleural effusions and respiratory failure. Management of hepatic hydrothorax can be difficult because these patients often have a number of comorbidities and potential for complications. Minimal high-quality data are available for guidance specifically related to hepatic hydrothorax, potentially resulting in pulmonary or critical care physician struggling for best management options. We therefore provide a Case-based presentation with management options based on currently available data and opinion. We discuss the role of pleural interventions, including thoracentesis, tube thoracostomy, indwelling tunneled pleural catheter, pleurodesis, and surgical interventions. In general, we recommend that management be conducted within a multidisciplinary team including pulmonology, hepatology, and transplant surgery. Patients with refractory hepatic hydrothorax that are not transplant candidates should be managed with palliative intent; we suggest indwelling tunneled pleural catheter placement unless otherwise contraindicated. For patients with unclear or incomplete hepatology treatment plans or those unable to undergo more definitive procedures, we recommend serial thoracentesis. In patients who are transplant candidates, we often consider serial thoracentesis as a standard treatment, while also evaluating the role indwelling tunneled pleural catheter placement may play within the course of disease and transplant evaluation. |
Databáze: | OpenAIRE |
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