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Hepatic Hydrothorax - Causes, Diagnosis, and Treatment

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Hepatic hydrothorax is fluid accumulation in the pleural space in patients with cirrhosis. This article explains more about its causes and treatment.

Written by

Dr. Janani R S

Medically reviewed by

Dr. Ghulam Fareed

Published At January 19, 2023
Reviewed AtMay 29, 2023

Introduction:

Hepatic hydrothorax occurs in patients with cirrhosis, a chronic liver disease. It occurs due to fluid build-up in the pleural space. The condition is found by analyzing the fluid extracted from the chest cavity and a few imaging techniques. Symptoms like cough, shortness of breath, tiredness, and chest pain occur in hepatic hydrothorax patients. Hepatic hydrothorax is treated with medications, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation.

What Is Hepatic Hydrothorax?

It is the water (hydro) or fluid build-up in the pleural space due to liver (hepatic) disease. It is called pleural effusion. It occurs in patients with cirrhosis (scarring of healthy liver tissues). The fluid from the ascites moves directly into the pleural cavity. Patients with cirrhosis have ascites (fluid accumulation in the belly) due to increased pressure in the blood vessels that supply the liver. The scar tissue blocks the blood circulation in the liver and affects the kidney functions over time, and excess salt is not removed from the body. The salts hold extra fluids and eventually lead to fluid accumulation.

Pleura is thin, double-layered tissue that lines the lungs and the inside of the chest cavity. Pleural space is the gap between the pleura. When there is fluid stocked up in the pleural space, it is called pleural effusion. The pleural effusion is of two types: transudate and exudate. Transudate effusion occurs when a pressure imbalance occurs in the blood vessels leading to leakage into the pleural cavity. It is seen in patients with cirrhosis and heart diseases. Exudate effusion occurs when the pleura is injured or swollen. It is seen in patients with pneumonia (lungs air sacs become swollen due to infection), cancer, and kidney diseases.

What Causes Hepatic Hydrothorax?

The exact causes of hepatic hydrothorax are unclear. The fluid from the ascites in the abdominal cavity moves into the pleural space through the diaphragm. A few damages to the tissues in the diaphragm make way for fluid entry. The pleural effusion becomes more prominent when the pleural space's storage capacity is exceeded.

Portal hypertension (high pressure in the blood vessels that supply the liver) causes ascites, leading to pleural effusion. Portal hypertension is common in cirrhosis patients, as the scar tissue blocks or constricts the size of the blood vessel. It causes pressure build-up in the blood vessel, and it ruptures. The fluids escape into the neighboring structures leading to excess fluid storage in the belly.

What Are the Symptoms of Hepatic Hydrothorax?

Hepatic hydrothorax has no specific symptoms as it generally occurs along with ascites. If the pleural effusion is massive, then the following symptoms may appear:

  • Feeling short of breath.

  • Cough.

  • Respiratory failure (the blood has increased carbon dioxide and reduced oxygen).

  • Chest pain.

  • Feeling weak and tired.

What Are the Tests to Find Hepatic Hydrothorax?

  • Physical Examination: The doctor looks at the patient for any signs of swelling in the abdomen.

  • Analyzing Pleural Fluid: A puncture is made in the chest cavity to access the pleural space and extract the fluid for evaluation. It will help confirm if the effusion is a transudate or exudate type.

  • Radioisotope Scintigraphy: A radiotracer 99 m Tc sulfur colloid is injected to look for the tracer's pathway. It is a confirmatory test for hepatic hydrothorax. The result is positive for hepatic hydrothorax if the tracer travels from the peritoneal space to the pleural space.

  • Doppler Ultrasonography: High-frequency bouncing sound waves are used to capture images of the blood vessels. It shows the flow of fluid in the hepatic hydrothorax through the diaphragm.

  • Magnetic Resonance Imaging (MRI): Magnetic resonance imaging techniques use high-frequency sound waves in a magnetic field to capture images of internal organs and structures. It gives a detailed view of the tissues and organs.

How Is Hepatic Hydrothorax Treated?

  • Salt Restriction: A low-sodium (salt) diet is recommended for patients with hepatic hydrothorax.

  • Diuretics: Diuretics is a medicine used to reduce blood pressure in patients with elevated blood pressure. The drug acts by removing the excess salt and water in the body.

  • Thoracentesis: It is a procedure that is used to remove air or water from the lungs. A needle is inserted in the chest to access the pleural space. The trapped fluid in the pleural cavity is removed.

  • Transjugular Intrahepatic Portosystemic Shunt (TIPS): Transjugular intrahepatic portosystemic shunt creates an artificial passage between the portal vein (a blood vessel that supplies blood to the liver) and hepatic vein (a blood vessel that carries blood from the liver to the heart). A stent (a tiny metal tube) is placed between the blood vessels to establish communication between the hepatic and portal veins.

  • Liver Transplantation: Liver transplant is considered in severe cirrhosis and when other treatment methods are not beneficial. A whole liver or a part of a liver from a healthy donor is surgically implanted in the patient.

What Are the Complications of Hepatic Hydrothorax?

  • Acute Kidney Injury: It is the sudden failure of kidney functions due to excess build-up of toxins in the kidney. It happens within a few hours or a few days.

  • Hepatic Encephalopathy: It is a brain disorder due to liver damage when the liver does not remove toxins from the blood. These toxins reach the brain through circulation and damage the brain cells. It causes forgetfulness, disorientation, slurred speech, trembling hands, and confusion.

  • Risk of Mortality: There is an increased risk of mortality in patients with hepatic hydrothorax. Since the functions of most organs are compromised and lead to failure, the patient's death occurs in some cases.

What Is the Prognosis of Hepatic Hydrothorax?

The prognosis is poor in patients with hepatic hydrothorax. It occurs in patients with ascites and cirrhosis, and liver transplant and transjugular intrahepatic portosystemic shunt are the treatment of choice. However, most patients are not eligible for liver transplants, and there is an increased fatality risk.

Conclusion:

Hepatic hydrothorax is a rare type of pleural effusion that occurs only in patients with cirrhosis, and the effusion is above 500 ml (milliliter). Pleural effusion also occurs in patients with heart problems and lung diseases. But hepatic hydrothorax is different as it results due to cirrhosis, a chronic liver disease. In hepatic hydrothorax, the pleural effusion is on the right side only. The condition is found with a few imaging techniques and by analyzing the fluid in the pleural space. However, there are a few treatments, like thoracentesis and transjugular portosystemic shunt placement for hepatic hydrothorax, and liver transplantation is the best option. Although this is a severe and rare condition, visiting the doctor when the patient has ascites will help the physician choose the best treatment. A regular check-up with the doctor and monitoring fluid build-up will prevent complications and improve the patient's lifespan.

Frequently Asked Questions

1.

How Is Hepatic Hydrothorax Treated?

Treatment for hepatic hydrothorax usually involves a combination of diuretic treatment and, in certain cases, therapeutic thoracentesis, which involves inserting a chest tube to drain the collected fluid from the pleural cavity.

2.

How Is Hepatic Hydrothorax Identified?

Clinical examination, imaging tests such as chest X-rays or ultrasounds, and thoracentesis, which includes examining the fluid taken from the pleural cavity, are used in conjunction to diagnose hepatic hydrothorax. In a patient with liver cirrhosis and portal hypertension, the presence of transudative pleural effusion, often on the right side, suggests the diagnosis of hepatic hydrothorax.

3.

Is Hepatic Hydrothorax a Fatal Condition?

Hepatic hydrothorax is a potentially fatal illness that can become more serious if left untreated or if problems develop. However, the outcome can be improved, and the illness can be effectively treated with the right care and medical intervention.

4.

How Many People Who Have a Hepatic Hydrothorax Survive?

Hepatic hydrothorax survivorship rates are influenced by a number of variables, including the severity of the ailment, the success of therapy, and the underlying liver disease. In general, many people can obtain a good quality of life and survival rates with adequate medical management.

5.

What Does Hydrothorax Mean in Medicine?

The term "hydrothorax" in medicine describes the buildup of fluid in the pleural cavity or the area between the lungs and the chest wall. It can result in breathing problems, and other respiratory symptoms can be brought on by a number of illnesses.

6.

Why Is a Chest Tube Dangerous in a Hepatic Hydrothorax?

A chest tube might be risky in cases of hepatic hydrothorax due to the possibility of infection and bleeding in patients with liver disease-related poor coagulation. A fast reduction in blood pressure and related problems might result from the quick elimination of substantial volumes of fluid.

7.

What Distinguishes a Hydrothorax from a Pleural Effusion?

As a specific kind of pleural effusion, hydrothorax is the buildup of serous fluid in the pleural cavity as a result of liver cirrhosis and portal hypertension. A pleural effusion, on the other hand, is a more general term for the accumulation of fluid in the pleural space, which can result from a variety of conditions, including infections, heart failure, or cancers.

8.

How Can Liver Cirrhosis Result in a Hydrothorax?

Due to elevated pressure in the portal vein (portal hypertension), which results in fluid leaking from the liver's blood vessels into the abdominal cavity and eventually into the pleural space, liver cirrhosis can cause hydrothorax, an accumulation of fluid in the chest.

9.

What Are the Hepatic Hydrothorax’s Clinical Symptoms?

Dyspnea, discomfort or soreness in the chest, and diminished breath sounds on the afflicted side of the chest are all clinical signs of hepatic hydrothorax. Additionally, individuals may exhibit additional liver cirrhosis symptoms, such as ascites and abdominal edema.

10.

Is It Possible to Have Ascites Without Having Hepatic Hydrothorax?

It is true that ascites can exist without hepatic hydrothorax. Ascites, which is the term for an accumulation of fluid in the abdominal cavity, can be brought on by a number of illnesses, including renal disease, heart failure, liver cirrhosis, and several malignancies. Hepatic hydrothorax, which is distinct from ascites in the abdominal cavity, refers to the buildup of fluid in the pleural cavity.

11.

What Distinguishes a Hydropneumothorax from a Hydrothorax?

The condition known as a hydropneumothorax, which typically results from trauma or illness, is one in which both fluid (hydro-) and air (pneuma) build in the pleural cavity. Contrarily, hydrothorax, which is frequently observed in situations of liver cirrhosis and portal hypertension, is the buildup of only fluid in the pleural cavity. A hydropneumothorax differs from a hydrothorax because it contains air.

12.

How Frequent Is Hepatic Hydrothorax?

Hepatic hydrothorax is a very uncommon consequence of liver cirrhosis, occurring in around 5 to 10 % of cirrhotic individuals, and its occurrence varies depending on the population investigated and the prevalence of underlying liver disease.

13.

Is Unilateral Hepatic Hydrothorax Present?

Yes, there can be unilateral hepatic hydrothorax. It is unilateral, meaning it only affects one side of the chest, and it frequently occurs when the fluid collects more noticeably on one side due to differences in the structure of the diaphragm or the way fluid moves through the lymphatic channels.

14.

Why Is Chest Tube Insertion in Hepatic Hydrothorax Avoided?

Due to the higher risk of bleeding and infection in patients with liver cirrhosis, which can result in catastrophic consequences, chest tube placement in hepatic hydrothorax is avoided. Large amounts of fluid may drain quickly, which might also cause a fast decrease in blood pressure and possible hemodynamic instability.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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