Showing papers on "Hydrothorax published in 2007"

Hepatic hydrothorax: Pathophysiology diagnosis and management

Abstract: Hepatic hydrothorax is defined as a significant pleural effusion (usually greater than 500 ml) in a cirrhotic patient, without an underlying pulmonary or cardiac disease. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with a unilateral pleural effusion, most commonly right-sided. In the vast majority of cases, patients with hepatic hydrothorax have end-stage liver disease. Therefore, they should be considered potential candidates for orthotopic liver transplantation. Until the performance of transplantation, other therapeutic modalities should be applied in order to relieve symptoms and prevent pulmonary complications.

Isolated fetal hydrothorax with hydrops: a systematic review of prenatal treatment options.

Abstract: Objective To evaluate the effect of prenatal therapeutic interventions on perinatal outcome in pregnancies complicated by isolated fetal hydrothorax with hydrops. Methods A systematic review of the literature from January 1982 to January 2006 of perinatal outcome in pregnancies with isolated fetal hydrothorax with hydrops with any form of prenatal treatment was conducted. Results Forty-four articles met our selection criteria, reporting a total of 172 fetuses treated prenatally. Reported treatment options were single (n = 13) or serial thoracocentesis (n = 18), thoraco-amniotic shunt placement (n = 100) or a combination of thoracocentesis and shunting (n = 36). Four case-reports described pleurodesis with OK-432, (n = 3) and intrapleural injection of autologous blood (n = 2). Overall survival rate was 63%, ranging from 54% for single thoracocentesis to 80% in the 5 cases treated with pleurodesis, without statistically significant differences between the treatment modalities. Shunt-placement with or without prior thoracocentesis was most often described, with survival rates of 67 and 61% respectively. Discussion The available literature consists exclusively of case reports and case series. This systematic review suggests that with prenatal intervention, perinatal survival rates around 63% are possible. There is a need for prospective, adequately controlled studies with long-term follow-up to determine the best treatment and more reliable outcome data in pregnancies complicated by fetal hydrothorax with hydrops.

The outcome after transjugular intrahepatic portosystemic shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction: a long-term study in 28 patients.

Abstract: OBJECTIVES: Hepatic hydrothorax is a rare but challenging complication of cirrhosis. The Transjugular Intrahepatic Portosystemic Shunt (TIPS) appears as one of the most successful approach of therapy. METHODS: To assess long-term efficacy and safety, we reviewed 28 patients (Child B/C: 43/57%) who underwent TIPS placement for refractory hepatic hydrothorax in our institution between 1992 and 2001. RESULTS: The 30-days mortality was 14%, reaching 25% at 90 days. The one-year survival without liver transplantation was 41.2%. Reduction in the volume of pleural effusion and improvement in clinical symptoms was observed in 68% while a complete radiological and echographic disappearance of hydrothorax was documented in 57%. Statistical analysis showed that poor liver function was predictive of mortality and non-response. Of the different liver function parameters and in this small series, the Child-Pugh score was more discriminating than the recently described Mayo risk score. CONCLUSION: This study shows that TIPS is effective in the treatment of hepatic hydrothorax for selected patients. Poor liver function is a strong predictive of bad outcome.

Pleural effusions in the neonate.

Abstract: Purpose of reviewThis review highlights the pathophysiological mechanisms, incidence, clinical features, as well as the diagnosis and treatment of pleural effusions in the neonate.Recent findingsPleural effusions are rare except in hydropic neonates. Elevated pleural fluid/serum immunoglobulin G rat

Fetal Pleural Effusion

Abstract: Unlike trace pericardial fluid, which can be seen in normal fetuses, any fluid in the pleural space is abnormal.1,2 The incidence of fetal pleural effusion is unknown, but has been estimated to occur in 1 in 15,000 pregnancies in tertiary care centers.2,3,29 The actual incidence of primary fetal hydrothorax may be even higher if one considers that in many cases the condition may remain undiagnosed, it may resolve spontaneously, the fetus may be aborted, or death may occur soon after birth in outlying hospitals before transfer to a tertiary care center.2 Fetal hydrothorax, either unilateral or bilateral, is a pleural effusion that may be primary, due to chylous leak, or secondary, in which the effusions are part of a generalized fluid retention associated with immune or non-immune hydrops.2,4 The management of pleural effusion in the fetus is complicated by the difficulty in distinguishing primary from secondary hydrothorax. Chylothorax is the most common cause of pleural effusion in the newborn. Secondary fetal hydrothorax is far more common in the fetus than in the neonate. Irrespective of the underlying cause, fetal pleural effusions may be potentially responsible of fetal and neonatal death.3,4 This complication occurs as a consequence of pulmonary hypoplasia due to chronic intrathoracic compression, to hydrops developed from mediastinal shift, cardiac compression, and vena caval obstruction, which diminishes venous return to the heart, resulting in a low-cardiac output state5 and to the prematurity as a consequence of an excess of amniotic fluid secondary to the esophagic compression. Infants affected by pleural effusions usually present in the neonatal period with severe, and often fatal , respiratory insufficiency. This is either a direct result of pulmonary compression caused by the effusions, or due to pulmonary hypoplasia secondary to chronic intrathoracic compression.3,29 The overall mortality of neonates with pleural effusion is 25 percent, with a range from 15 percent in infants with isolated hydrothorax to 95 percent in those with gross pleural effusions.6,7,29 More recently, Longaker et al reported that the mortality rate in cases of antenatally diagnosed chylothorax was 53 percent.2 Fetal Pleural Effusion

Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension.

Abstract: SUMMARY The transjugular intrahepatic portosystemic shunt (TIPS) is a non-surgical intrahepatic shunt connecting the hepatic and portal veins. The shunt can be inserted successfully in more than 90% of patients and it effectively decompresses the portal venous circulation. Serious complications, such as intraperitoneal bleeding, occur but they are uncommon. The role of TIPS in the treatment of portal hypertension is currently being evaluated. There are few controlled data available to compare TIPS with established treatments such as drugs, injection sclerotherapy, endoscopic banding or shunt surgery. TIPS has also been used to treat ascites, the Buddxhiari syndrome and cirrhotic hydrothorax. Concerns over the long-term patency and the true incidence of encephalopathy following TIPS raise doubts about its long-term efficacy. Controlled trials are required to demonstrate the cost-effectiveness of TIPS for individual indications before it is widely adopted. TIPS may find its most immediate application in the emergency treatment of active variceal haemorrhage refractory to standard medical and endoscopic therapy, as there is no satisfactory treatment currently available for this high-risk group. TIPS may also have a role in patients awaiting liver transplantation who bleed from varices. Long-term patency should not be an issue in this patient group and portal decompression may reduce blood transfusion requirements during transplant surgery.

Acute hydrothorax complicating peritoneal dialysis

Abstract: AimTo determine whether gradually increasing the peritoneal dialysate fill volume from 10 to 40 mL/kg over 6 days, rather than commencing at 40 mL/kg, prevents hydrothorax in children and reverses ...

Pleural effusion with parenteral nutrition solution: an unusual complication of an "appropriately" placed umbilical venous catheter.

Abstract: Pleural effusion is not an uncommon complication of percutaneous intravenous catheters in neonates. Umbilical venous catheters (UVCs) are associated with pleural effusion following abnormal placement in the left atrium or pulmonary veins due to venous obstruction. We report for the first time a case of right-sided pleural effusion with parenteral nutrition solution following a UVC that appeared to be positioned appropriately in the inferior vena cava.

Simple surgical treatment for pleuroperitoneal communication without interruption of continuous ambulatory peritoneal dialysis

Abstract: Pleuroperitoneal communication is a complication of continuous ambulatory peritoneal dialysis (CAPD) that can necessitate cessation of CAPD. Hemodialysis was started on a 52-year-old woman and shifted to CAPD 1 month later. However, 18 days after initiation of CAPD, her chest radiograph showed a right-side hydrothorax. Thoracentesis yielded a colorless pleural effusion with markedly higher glucose levels than in her serum, indicating the presence of pleuroperitoneal communication. Three days later, thoracoscopic surgery was performed. A colored dialysis solution preoperatively injected into the abdominal cavity identified intraoperatively leakage from the diaphragm. The leakage points were closed by a no-knife-type automatic stapler with absorbable polyglycolic acid felt and fibrin glue. CAPD was restarted on the operative day, and there was no recurrence of the right hydrothorax. We conclude that this simple method can be used effectively to treat pleuroperitoneal communication.

Hydrops foetalis caused by hepatic haemangioma

Abstract: The authors report a moderately premature baby with Down's syndrome and hydrops, the latter probably caused by a large hepatic haemangioma which was diagnosed only after birth. At birth the baby was affected by massive right hydrothorax, ascites, hypoalbuminaemia and severe respiratory distress. With the use of modern neonatal intensive care, the baby survived. Corticosteroid treatment (prednisolone 2 mg kg -1 d -1 i.v. in divided doses) was associated with a very rapid resolution of the haemangioma and the baby was healthy at follow-up. Although hepatic angiomas are not uncommon in the neonatal period, the association with hydrops is a rare finding.

Fetal hydrothorax resolving completely after a single thoracentesis: a report of 2 cases.

Abstract: Background Although fetal hydrothorax is uncommon, perinatal mortality from it is high. The clinical course of fetal hydrothorax is highly variable. Despite some cases of spontaneous resolution, fetal hydrothorax progresses to nonimmune hydrops because of impaired venous return and congestive cardiac failure due to compression in many cases. Although the effect of thoracoamniotic shunting is established, the procedure is invasive and involves some risks. Cases Two cases of fetal hydrothorax completely resolved after a single thoracentesis. In the first case, thoracentesis was performed in a fetus with bilateral isolated pleural effusion at the gestational age of 20 weeks. Fetal hydrothorax achieved complete resolution after a single thoracentesis was performed, and the perinatal outcome was good. In the second case, we performed thoracentesis in a fetus with a unilateral pleural effusion and skin edema at the gestational age of 17 weeks. Complete resolution was achieved after a single thoracentesis, and the outcome was uneventful. Conclusion Thoracentesis is a comparatively simple procedure for mothers and fetuses and should be the first choice for treating fetal hydrothorax.

Supradiaphragmatic and transdiaphragmatic intrathoracic migration of a ventriculoperitoneal shunt catheter.

Abstract: A hydrothorax following ventriculoperitoneal shunt catheter insertion is very rare and usually reported in children. Only about 25 cases have been described in the literature and very few have been adults. We report a 51-year-old woman with a massive hydrothorax and respiratory distress following both supradiaphragmatic and transdiaphragmatic migration of a ventriculoperitoneal shunt catheter into the pleural space. To our knowledge this is the first report of the simultaneous occurrence of two types of such migration in one patient.

Primary cardiac fibrosarcoma with pulmonary metastasis in a Labrador Retriever.

Abstract: A 6–year-old, neutered male Labrador Retriever was diagnosed with congestive heart failure, and an echocardiogram revealed a large mass inside the pericardial sac associated with the left ventricle. At necropsy, the dog had marked ascites, mild hydrothorax, marked hydropericardium, and an 11.0 X 7.0 X 6.0 cm, tan and red, firm, well-demarcated mass attached to the left ventricular free wall. The mass was diagnosed as a fibrosarcoma based on the morphologic appearance and supportive immunohistochemical staining. To our knowledge, this is the first case report of a primary fibrosarcoma involving the left ventricular free wall myocardium, epicardium, and pericardium with a pulmonary metastasis in a dog.

Successful treatment of a case of severe electrical burns with heart and lung injuries.

Abstract: A patient sustained high-voltage electrical burns with third-degree burns over 35.5% of his body surface, which included a large direct wound on the left chest wall, exposing the heart. The heart and lungs were severely injured. Subsequently, hydrothorax, hydropericardium, and respiratory failure developed. He was successfully treated with fluid resuscitation, antibiotics, drainage of the pericardium and pleural cavities, early removal of necrotic tissue, skin grafting, and reconstruction of the chest wall with a 13 x 27-cm delay-flap, as well as a number of supportive measures. The patient gradually recovered and was discharged in 6 months.

Hydrothorax as the sole manifestation of ovarian hyperstimulation syndrome: unusual case and literature review

Abstract: An unusual case of a unilateral massive hydrothorax after IVF treatment is reported in a 41-year-old patient, which developed as the only manifestation of ovarian hyperstimulation syndrome. The literature on such rare presentation is also reviewed to highlight its diagnostic features and prognosis.

Meig's or Pseudomeig's syndrome?

Abstract: The triad of ascites, hydrothorax in association with a benign ovarian tumor is defined as Meig's syndrome. It is a rare clinical entity. A case of a 62 year-old woman whith dyspnoe, abdominal discomfort and ascites is presented. Clinical and ultrasonographic findings revealed extended palpable pelvic mass originating from the ovaries and ascites as well as hydrothorax of the left lung by chest radiography. The treatment method was surgical intervention. Cytomorphologic studies were positive for malignacy and adenocarcinoma cells were confirmed. The pathogenesis of the pleural and ascites fluids and the importance of CA-125 are discussed (Fig. 2, Ref. 21).

Tension chylothorax in two pediatric patients.

Abstract: Summary Although the accumulation of gas is the most common cause of an expanding interpleural space, the presence of other structures or substances (hydrothorax, gastrothorax, hemothorax, urohemothorax, pyothorax, and chylothorax) under pressure may be sufficient to cause hemodynamic and respiratory compromise. We present two pediatric patients that developed hemodynamic and respiratory effects secondary to a chylothorax. The first patient presented in respiratory distress and cardiovascular collapse 4 weeks after a Fontan procedure. Placement of a chest tube resulted in the release of chyle under pressure and prompt resolution of hemodynamic and respiratory symptoms. The second patient was a 2100 g neonate who developed a chylothorax during an episode of sepsis following gastroschisis repair. On two separate occasions, the development of the chylothorax was associated with tachycardia, oliguria, and increased requirements during mechanical ventilation. Chest tube placement resulted in the release of chyle under pressure and resolution of the symptoms. These two cases demonstrate that chylothorax like pneumothorax can have deleterious effects on hemodynamic and respiratory function.

Hydrothorax following ovarian hyperstimulation for assisted reproduction. Case report and review of the literature.

Abstract: In case of ovarian hyperstimulation syndrome, the high incidence of dyspnea in relation with ascites and enlarged ovaries should not justify omission of thoracic evaluation. This manuscript reviews the pathogenesis and clinical presentation of hydrothorax following controlled ovarian hyperstimulation. In addition, we describe the case of a 33-year-old woman with a right massive hydrothorax resulting from controlled ovarian hyperstimulation for intracytoplasmic sperm injection.

Hydrothorax after Central Vein Catheterization for Right Internal Jugular Vein and Contralateral Reexpansion Pulmonary Edema after Right Chest Tube Insertion -A case report-

Abstract: Cannulation of a large central vein is the standard clinical method for mornitoring CVP and is also performed for a number of additional therapeutic interventions, such as providing secure vascular access for administration of vasoactive drugs or to initiate rapid fluid resuscitation in operation or for aspiration of air emboli. But there are many complications such as vessel injury, pneumothorax, nerve injury, arrhythmias, arteriovenus thrombus, pulmonary emboli, infection at insertion site, because there are major vessels, nerve and organs around of central veins. We report a case of Rt. Hydrothorax after internal jugular vein cannulation and a contralateral reexpansion pulmonary edema and pleural effusion after Rt. chest tube insertion for hydrothorax. (Korean J Anesthesiol 2007; 53: 234~7)

Isolated severe hydrothorax with respiratory distress as a main manifestation of ovarian hyperstimulation syndrome preceded by respiratory tract infection caused by Haemophilus influenzae.

Abstract: Introduction: An isolated unilateral pleural effusion as the only presentation of ovarian hyperstimulation syndrome (OHSS) is very rare. This case is an unusual presentation of OHSS after a confirmed respiratory tract infection, with no other coexisting risk factors identified for this syndrome. We also imply that the presence of Haemophilus influenzae in bronchial fluid can increase local reaction to vasoactive cytokines. Case Report: A 32-year-old woman presented at the Department of Reproductive Medicine and Gynaecology of the Pomeranian Medical University after 10 years of infertility with diagnosed hyperprolactinemia followed by bromocriptine treatment. The patient had three IUIs but no pregnancy was achieved. Therefore, ICSI was proposed. After an ovarian hyperstimulation, oocyte aspiration gave 8 oocytes. Although ICSI was performed in all of the oocytes there were 3 fertilizations. The ET of 3 embryos was carried out following 3 days of culture. Three weeks before the gonadotropin administration and a week before GnRH administration the patient had a respiratory tract infection with the most typical syndromes. The infection was treated successfully with over-the-counter medications and antibiotic .Three days after ET the patient was admitted to the ICU with signs of severe dyspnoea. The chest Xray showed a large pleural effusion over the right lung. Upon admission, thoracocentesis was preformed and 1600 ml of clear fluid was aspirated. The bronchial aspirate showed evidence of Haemophilus influenzae and leukocytes. After three days of standard treatment the chest X-ray revealed no pathology. The patient was discharged asymptomatic on the 4th day of treatment. Serum beta-hCG level was negative on day 12 after ET. Conclusions: This case suggest that respiratory tract infection prior to stimulation may constitute a new independent risk factor for OHSS. However, the true relation between the respiratory tract infection and susceptibility to OHSS still awaits explanation. Recent or existing respiratory tract infection may be a relative contraindication for starting COH.

Hepatic hydrothorax occurring rapidly after manual abdominal compression.

Abstract: Hepatic hydrothorax is a relatively infrequent but potentially serious complication of liver cirrhosis that often causes respiratory dysfunction. Several hypotheses for the development of hepatic hydrothorax have been suggested to explain a transdiaphragmatic shift of ascitic fluid through small defects between the peritoneal cavity and the pleural space. However, the rapid development of hydrothorax within several hours is seldom encountered. In addition, the causal factors for rapid passage of ascitic fluid into the pleural cavity are unknown. This report describes a patient with liver cirrhosis who suffered rapid development of a hydrothorax after manual compression of the abdomen.

Unrecognized massive hydrothorax during supracostal approach for percutaneous nephrostolithotomy

Abstract: In the last years percutaneous nephrolithotomy is very often used in the therapy of urinary calculi. Supracostal approach is favorable in the therapy of upper calices calculi, but the risk of pneumothorax and hydrothorax should be considered. In our case report; a hydrothorax complication of percutaneous nephrolithotomy performed via supracostal approach is presented.

Minimal access puncture drainage apparatus for seroperitoneum and hydrothorax

Abstract: The utility model relates to a medical instrument, in particular to a minimal access puncture drainage apparatus for seroperitoneum and hydrothorax. The model comprises by turns a drainage pack (1), a murphy dropper (2), a flow accommodator (3), a base joint (4), a top joint(9), a butterfly fixation clamp (5), and a drainage catheter (6) from lower to up; an injection cap (8) is arranged between the top and the base joint, the drainage catheter is also provided with scale. Beneficial effect is: operation is simple, price is low, microtrauma is continuous, drainage is complete, the model is not easy to infect, can remain catheter for a long time, no sinuses leaves after extubate, length of stay is short, economic burden is eased; the model can be used to drain pleural effussion, cavitas pericardialis fluidify, seroperitoneum, and bladder stoma of bladder retention of urine.

A case of left isomerism with early fetal decompensation.

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Thoracic cavity hydrops negative pressure drain device

Abstract: A hydrothorax vacuum drainage device belongs to the technical field of medical appliance. The medical care personnel in special hospitals have to extract the hydrothorax of the patient one by one, which is not only very troublesome but also uneasy to control the amount of the extracted hydrothorax. The technical proposal of the utility model is that one ends of a drainage tube 5 and a vacuum suction tube 2 are respectively provided with an inserted hydrothorax holding bottle 3 with a measuring scale 4. A switch 1 is positioned on the vacuum suction tube 2. The other end of the drainage tube 5 is fixedly connected and communicated with a syring needle 7. A switch 6 is positioned on the drainage tube 5. The utility model has the advantages that the hydrothorax vacuum drainage device is provided with a rational and practical structure and the skillful and novel design. The continuous suction of the hydrothorax and the remote operation can be carried out by using this utility model. Meanwhile, the suction amount of the hydrothorax can be controlled at any moment. The utility model is provided with simple and convenient operation, and saves both time and power.

[Isolated hydrothorax of a fetus--description of the clinical situation].

Abstract: A diagnostic procedure in the medical treatment of middle hydrothorax at haemodynamically efficient fetus has been presented in the research. Container of the liquid in the fetal thorax has been observed since the eleventh week of pregnancy. Infection by TORCH viruses has been excluded and typical 46,XX female karyotype has been found in the cytogenic test. A liquid in the pericardial sack (without any sings of the fetal heart defect) was observed in the ECHO examination from 23 to 37 week of pregnancy. Cesarean section was made after 37 weeks of pregnancy and the new-born baby was found to be in good condition, with body mass of 3130g and 9 points in the Apgar scale. The child cardiologist did not diagnose any heart disorders. Awaiting attitude, while monitoring the state of the fetus, seems to be the right course of action in cases of haemodynamically efficient fetus with isolated hydrothorax.

Isolated severe hydrothorax with respi- ratory distress as a main manifestation of ovarian hyperstimulation syndrome preceded by respiratory tract infection caused by Haemophilus influenzae

Abstract: Introduction: An isolated unilateral pleural effusion as the only presentation of ovarian hyperstimulation syndrome (OHSS) is very rare. This case is an unusual presentation of OHSS after a confirmed respiratory tract infection, with no other coexisting risk factors identified for this syndrome. We also imply that the presence of Haemophilus influenzae in bronchial fluid can increase local reaction to vasoactive cytokines. Case Report: A 32-year-old woman presented at the Department of Reproductive Medicine and Gynaecology of the Pomeranian Medical University after 10 years of infertility with diagnosed hyperprolactinemia followed by bromocriptine treatment. The patient had three IUIs but no pregnancy was achieved. Therefore, ICSI was proposed. After an ovarian hyperstimulation, oocyte aspiration gave 8 oocytes. Although ICSI was performed in all of the oocytes there were 3 fertilizations. The ET of 3 embryos was carried out following 3 days of culture. Three weeks before the gonadotropin administration and a week before GnRH administration the patient had a respiratory tract infection with the most typical syndromes. The infection was treated successfully with over-the-counter medications and antibiotic .Three days after ET the patient was admitted to the ICU with signs of severe dyspnoea. The chest X- ray showed a large pleural effusion over the right lung. Upon admission, thoracocentesis was preformed and 1600 ml of clear fluid was aspirated. The bronchial aspirate showed evidence of Haemophilus influenzae and leukocytes. After three days of standard treatment the chest X-ray revealed no pathology. The patient was discharged asymp- tomatic on the 4th day of treatment. Serum beta-hCG level was negative on day 12 after ET.