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Semin Respir Crit Care Med 2010; 31(6): 698-705
DOI: 10.1055/s-0030-1269829
© Thieme Medical Publishers

Pleural Effusion in Liver Disease

José Castellote Alonso1
  • 1Hepatología y Unidad de Trasplante Hepático, Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Publication History

Publication Date:
06 January 2011 (online)

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ABSTRACT

Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis. It is defined as a pleural effusion in a patient with portal hypertension and no cardiopulmonary disease. The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. Thoracentesis and pleural fluid analysis are necessary for diagnosis. Initial management consists of sodium restriction, diuretics, and therapeutic thoracentesis. A transjugular intrahepatic portosystemic shunt may provide a bridge prior to liver transplantation. Spontaneous bacterial empyema is the infection of a preexisting hydrothorax. The more frequent bacteria involved are Enterobacteriaceae and gram-positive cocci. Antibiotic therapy is the cornerstone of therapy. This article reviews etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension.

KEYWORDS

Hepatic hydrothorax - pleural effusion - liver cirrhosis

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José Castellote AlonsoM.D. 

Hepatología y Unidad de Trasplante Hepático, Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n

08907 L'Hospitalet de Llobregat, Barcelona, Spain

Email: jcastellote@bellvitgehospital.cat