Showing papers on "Hydrothorax published in 2017"

Hepatic hydrothorax: An update and review of the literature.

Abstract: This review considers the modern concepts of pathogenesis, diagnostic methods, and treatment principles of hepatic hydrothorax (HH). HH is the excessive (> 500 mL) accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases. It causes respiratory failure which aggravates the clinical course of liver cirrhosis, and the emergence of spontaneous bacterial pleural empyema may be the cause of death. The information was collected from the PubMed database, the Google Scholar retrieval system, the Cochrane reviews, and the reference lists from relevant publications for 1994-2016 using the keywords: "liver cirrhosis", "portal hypertension", "hepatic hydrothorax", "pathogenesis", "diagnostics", and "treatment". To limit the scope of this review, only articles dealing with uncomplicated hydrothorax in patients with liver cirrhosis were included. The analysis of the data showed that despite the progress of modern hepatology, the presence of HH is associated with poor prognosis and high mortality. Most patients suffering from it are candidates for orthotopic liver transplantation. In routine clinical practice, stratification of the risk for an adverse outcome and the subsequent determination of individual therapeutic strategies may be the keys to the successful management of the patient's condition. The development of pathogenetic pharmacotherapy and optimization of minimally invasive treatment will improve the quality of life and increase the survival rate among patients with HH.

Thoracoamniotic Shunting for Fetal Hydrothorax: Predictors of Intrauterine Course and Postnatal Outcome

Abstract: Objective: To assess predictors for survival and complications among a relatively large cohort of fetuses with hydrothorax treated by thoracoamniotic shunting. Methods: All cases with hydrothorax treated by thoracoamniotic shunting in a 10-year period (2002-2011) in two centers were retrospectively reviewed. Results: A total of 78 fetuses with hydrothorax treated with thoracoamniotic shunting were included in the study. Mean gestational age at diagnosis was 25.6 weeks (12-34 weeks). Initial thoracoamniotic shunting was performed at a mean gestational age of 26.5 weeks (16-33 weeks). A mean of 2.53 shunts (1-7) were inserted per fetus. Of the 78 fetuses, 9 (11.5%) died in utero, 69 (88.5%) were born alive and 46 (59%) survived. Prognostic markers significantly associated with nonsurvival were polyhydramnios, hydrops placentae and mediastinal shift at initial scan, onset of hydrops after first shunt placement, rupture of membranes, a shunt-birth interval Conclusions: Although associated with a significant rate of repeated interventions, thoracoamniotic shunting in fetuses with severe hydrothorax results in an overall survival rate of 59%. Fetuses with hydrothorax and trisomy 21 have a better survival when compared to euploid fetuses.

The prognostic factors and outcomes of primary fetal hydrothorax with the effects of fetal intervention.

Abstract: Objectives This study aims to determine the prognostic factors and outcomes of primary fetal hydrothorax (FHT) and investigate the effects of fetal therapy. Methods A nationwide survey was conducted on fetuses with primary FHT delivered after 22 weeks of gestation between January 2007 and December 2011 at perinatal centers. Results Among the 287 cases of primary FHT, the survival rates for those with and without hydrops were 58.0% (113/195) and 97.8% (90/92), respectively. The survival rates in the no-therapy, thoracocentesis, and thoracoamniotic shunting (TAS) groups in the hydropic cases and the non-hydropic cases were 59.7% (40/67), 51.5% (35/68), and 63.3% (38/60) and 98.1% (53/54), 96.3% (26/27), and 100% (11/11), respectively. The crude relative risk for death was 2.1 (p = 0.005) for fetuses diagnosed at 26 to 30 weeks of gestational age (vs ≥30 weeks), 2.3 (p = 0.001) for both skin edema and ascites, and 3.1 (p = 0.02) for bilateral pleural effusion. TAS was associated with a significant risk reduction for death in hydropic cases [adjusted relative risk 0.61, p = 0.01 (vs no fetal therapy)]. Conclusions Hydrops and an early gestational age at diagnosis (<30 weeks of gestation), skin edema with ascites, and bilateral effusion predicted a poor prognosis in primary FHT cases. TAS was associated with a higher survival rate. © 2016 John Wiley & Sons, Ltd.

Thoracic Changes after Full Laser Ablation of the Feeding Artery in Fetuses with Bronchopulmonary Sequestration.

Abstract: Objective To assess longitudinal intrathoracic changes after fetal laser surgery in fetuses with bronchopulmonary sequestration (BPS) with hydrops and/or hydrothorax. Study design The presence of intrafetal fluid effusions, the lung mass volume ratio (congenital pulmonary airway malformation volume ratio [CVR]), and the observed/expected lung-to-head circumference ratio (O/E-LHR) of both lungs were evaluated in a cohort of BPS fetuses with hydrops and/or hydrothorax treated with full laser ablation of the feeding artery (FLAFA). The longitudinal changes in intrafetal fluid effusions, lung mass volume, and pulmonary growth were analyzed by survival and multilevel analysis against days after FLAFA. Results FLAFA was successfully performed in 15 cases at a median gestational age of 26.9 weeks. A complete disappearance of the hydrops and hydrothorax was observed a median interval of 7.5 and 21 days after the fetal intervention, respectively. A progressive decrease in the CVR and an increment in the size of both lungs were observed after FLAFA. The O/E-LHR of the lung contralateral and ipsilateral to the side of the BPS became normal on average 8 and 10 weeks after FLAFA, respectively. Conclusion Fetal laser surgery with FLAFA promotes disappearance of all fetal fluid effusions, a lung mass regression sequence, and a normalization of pulmonary growth.

Can oesophagectomy be performed for patients with oesophageal carcinoma and concomitant liver cirrhosis? A retrospective study based on a propensity-matched cohort.

Abstract: Objectives For patients with oesophageal carcinoma and concomitant liver cirrhosis, the safety profile and postoperative prognosis of oesophagectomy are not clearly established due to the lack of relevant studies with large sample sizes Our objective was to explore the surgical indications and postoperative prognosis in patients with oesophageal carcinoma and liver cirrhosis Methods A total of 2226 patients with oesophageal carcinoma underwent curative oesophagectomy (37 with liver cirrhosis and 2189 without) in our department from April 2008 to September 2013 Overall, 37 patients with liver cirrhosis (30 Child-Pugh Grade A and 7 Child-Pugh Grade B) and a propensity-matched cohort of 74 patients without cirrhosis were analysed We compared the rates of postoperative complications and 5-year survival in these 2 groups In addition, we performed an analysis of any potential risk factors for death, including patient demographic information and of operation performed Results A higher operative mortality rate was observed in patients with oesophageal carcinoma and liver cirrhosis compared to patients with oesophageal carcinoma but without cirrhosis (11 vs 1%, P = 0042) Patients with cirrhosis included those with Child-Pugh Grade B (43%), preoperative moderate ascites (100%), a prothrombin time of ≥ 4 s (75%) and greater weight loss Although the rates of surgical death and postoperative hydrothorax were significantly higher in patients with liver cirrhosis, the rates of other major complications and 5-year overall survival were not significantly different compared to patients without cirrhosis Conclusions Curative oesophagectomy is a feasible, beneficial treatment option for patients with oesophageal carcinoma and liver cirrhosis, with a higher perioperative risk but reasonable longer term survival compared to patients without cirrhosis

Peritoneal Dialysis Complicated by Pleuroperitoneal Communication and Hydrothorax.

Abstract: Background: Hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. It is a potentially serious condition that frequently requires cessation of peritoneal dialysis and permanent transition to hemodialysis. Hydrothorax is produced by movement of peritoneal dialysate through pleuroperitoneal fistulas. Pleural fluid analysis typically detects a high glucose concentration, and contrast imaging reveals tracer uptake transgressing the diaphragm. Experience with the treatment of hydrothorax related to peritoneal dialysis is limited. Case Report: We describe the case of a 54-year-old female on peritoneal dialysis for end-stage renal failure who developed a hydrothorax soon after beginning treatment. Conclusion: This case describes a classical presentation of hydrothorax in the context of peritoneal dialysis. Treatment is frequently unsuccessful. All clinicians prescribing peritoneal dialysis should be aware of this complication.

The outcomes and prognostic factors of fetal hydrothorax associated with trisomy 21

Abstract: Objectives To determine the characteristics, outcomes, and prognostic factors of fetal hydrothorax (FHT) with trisomy 21 Methods A nationwide survey was conducted on FHT fetuses with trisomy 21 delivered after 22 weeks' gestation between January 2007 and December 2011 at perinatal centers Results The 91 cases of FHT with trisomy 21 included 28 (308%) diagnosed in utero and 63 (692%) diagnosed after birth The natural remission rate was 66% (6/91) Thoracoamniotic shunting was performed in 143% (13/91) of cases The survival rates of the hydropic, nonhydropic, and total cases were 470% (31/66), 840% (21/25), and 571% (52/91), respectively The crude odds ratio for death was 82 (p = 0003) for fetuses diagnosed at 26-30 weeks of gestational age (vs ≥30 weeks), 59 (p = 0003) for hydrops, 40 (p = 004) for bilateral pleural effusion, 068 (p = 042) for associated cardiovascular anomalies, and 21 (p = 026) for thoracoamniotic shunting (vs no fetal therapy) Conclusions The prognosis of FHT with trisomy 21 was not very poor, but it was still worse than that of primary FHT Hydrops, an early gestational age at the diagnosis and bilateral effusion, but not associated anomalies, were risk factors for death Fetal therapy showed no survival benefit for FHT with trisomy 21 © 2017 John Wiley & Sons, Ltd

Fetal pleural effusion and Down syndrome.

Abstract: Fetal pleural effusion is a rare abnormality that results from accumulation of fluid in the chest cavity. It can be classified as primary fetal hydrothorax and secondary fetal hydrothorax. The underlying causes of pleural effusion are still unknown, and the current treatment strategies are mainly based on symptoms. The prognosis of fetal pleural effusion varies significantly, ranging from spontaneous resolution to perinatal death. Recent advances in prenatal diagnostic methods and treatment such as thoracoamniotic shunting have significantly improved the survival rates for patients with or without hydrops.

Hidrotórax como complicación de la derivación ventriculoperitoneal: caso clínico

Abstract: The ventricle peritoneal (VP) shunt is commonly used in the treatment of hydrocephalus. It is a relatively simple and effective technique, but around 70% of the patients with a VP shunt have a complication in their lifetime. Most of these complications are due to infection or mechanical dysfunction. The thoracic complications are rare. The present case is one of the small number of them found in the literature, describing hydrothorax as a complication of a VP shunt without catheter migration and without ascites. The case is presented of a 2 year-old girl with VP shunt. The patient was diagnosed with pleural effusion compatible with hydrothorax. After finding beta-2-transferrin in the pleural fluid, it was it was shown to be from cerebrospinal fluid. Cranial CT showed the catheter in a proper position, and the Xray and ultrasound showed the catheter correctly positioned in the peritoneum.

Surgical Repair of Pleuroperitoneal Communication with Continuous Ambulatory Peritoneal Dialysis.

Abstract: Background Pleuroperitoneal communication is a serious complication in patients receiving continuous ambulatory peritoneal dialysis. However, few single-institutional reports discuss the details of pleuroperitoneal communication in continuous ambulatory peritoneal dialysis patients regarding the intraoperative findings, postoperative course, and outcomes. Methods We retrospectively reviewed the records of consecutive pleuroperitoneal communication patients who were treated surgically from September 2008 to March 2016. Results All four patients had right-sided hydrothorax. The time from introduction of continuous ambulatory peritoneal dialysis to the diagnosis of hydrothorax ranged from 1 to 12 months (average: 5.5 months). Case 1 and case 4 had bleblike lesions near the center of the diaphragm; case 2 had a small hole located near the cardiophrenic angle, and case 3 had thinning of the diaphragm near the cardiophrenic angle. All lesions except for case 3 were directly closed with absorbable suture and reinforced by fibrin glue and a polyglycolic acid sheet. In case 3, the thinned diaphragm was reinforced using fibrin glue, a sealing sheet, and pericardial fat pad tissue. Continuous ambulatory peritoneal dialysis was reinitiated an average period of 11 days (range: 4–15 days) postoperatively. During postoperative follow-up, there was no recurrence of hydrothorax. Continuous ambulatory peritoneal dialysis was continued for an average of 16.7 months (range: 3–34 months) after surgical treatment. Conclusions Surgical treatment for pleuroperitoneal communication is a safe and acceptable procedure and could greatly benefit continuous ambulatory peritoneal dialysis patients.

Usefulness of Medical Thoracoscopy in the Management of Pleural Effusion Caused by Chronic Renal Failure.

Abstract: Introduction Although pleural effusion (PE) can be caused by several pathologies like congestive heart failure, infections, malignancies, and pulmonary embolism, it is also a common finding in chronic kidney disease (CKD) Diagnostic thoracentesis is of limited value in the differential diagnosis, and the role of more invasive investigations like medical thoracoscopy (MT) is still unclear Aim To evaluate the usefulness of MT in unexplained PE in CKD Materials and methods In the electronic database of our Institution, we retrospectively searched for patients with CKD who underwent MT for unexplained PE between January 2008 and August 2016 Results Ten patients were included in the present study The average age was 724 years, the male:female ratio 9:1 and the average blood creatinine value 596 mg/dL The average follow-up was 18 monthsA thoracentesis showed an exudate was found in 9 patients and in 1 case pleural fluid characteristics were not recorded for technical reasons; in none of them the cytologic or microbiological analyses were considered diagnosticThe clinical suspicion was a neoplastic (5) or an infectious disease (5) In 4 patients with recurrent PE, MT was performed to obtain talc pleurodesisNo immediate procedure-related complications were recorded; 1 patient developed empyema after 2 months In 6 cases final diagnosis was chronic uremic pleuritis, hydrothorax in 2, and chronic lymphocytic pleurisy in 2 Conclusions MT represents a safe and effective diagnostic and therapeutic procedure in patients with CKD, that itself is a common cause of exudative effusion, and those patients may not require MT

Pseudoamniotic Band Syndrome Post Fetal Thoracoamniotic Shunting for Bilateral Hydrothorax.

Abstract: Introduction: Pseudoamniotic band syndrome (PABS) occurs iatrogenically after fetal surgery or amniocentesis due to chorioamniotic membrane separation. Separation of the amnion from the chorion can expand to form fibrous amniotic bands that can envelope fetal limbs or the umbilical cord, with consequences ranging from limb constriction to fetal demise. Case Report: We report a case of bilateral fetal pleural effusions at 27 weeks' gestation treated by bilateral thoracoamniotic shunts. Following shunt placement, the hydrothorax resolved. However, chorioamniotic membrane separation developed resulting in PABS with subsequent umbilical cord strangulation and fetal demise at 32 weeks' gestation. Conclusion: PABS has been previously described in the literature following various fetal interventions. This is the first reported case of pseudoamniotic band syndrome after placement of fetal thoracoamniotic shunts. A high index of suspicion is required to diagnose PABS via postoperative ultrasound. Post inte...

Endoscopic ultrasound-guided evaluation of the pleura and cases of pleural effusion

Abstract: The most efficient and cost-effective approach for the diagnosis of pleural exudates remains uncertain and is a subject of controversy. Essential factors to be considered include the respective diagnostic yields of thoracocentesis, closed pleural biopsy, and thoracoscopy. The role of endoscopic ultrasound (EUS) of the esophagus as a modality for the evaluation of pleural exudates has not yet been evaluated. The applied anatomy of the pleura has been discussed. The techniques involved in the EUS imaging of different aspects of the pleura in normal cases and in cases with pleural effusion are elaborated. The practical application of this knowledge can be useful in EUS-guided sampling of the pleural wall, pleural nodules, and in cases of pleural effusion.

A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF.

Abstract: We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants of the diaphragm. The patient had no known risk factors for OHSS and only a moderate number of oocytes aspirated. She received, however, repeated hCG injections for luteal support. The patient did not achieve pregnancy but was hospitalized due to pain in the right side of the chest and dyspnoea. A chest computed tomography (CT) showed a pleural effusion on the right side. Total of 1000 ml of pleural fluid was drained after a single thoracentesis. After three days, the symptoms and fluid production ceased. Ascites is a common finding in OHSS, but pleural effusions are rare. Further, isolated pleural effusions have not previously been described in a patient with endometriosis. We suggest that the repeated hCG injections induced effusions from the endometriotic lesions at the diaphragm and as a consequence this patient developed isolated hydrothorax.

Pleural effusion from pleuroperitoneal communication.

Abstract: A 52yearold woman with endstage renal disease for chronic glomerulonephritis was started on inpatient peritoneal dialysis (PD). We increased infusion volume of PD exchange every 2 days without observing any symptoms, including respiratory symptoms. After changing infusion volume on the 5th day, the patient complained of dyspnea and continuous cough. Decreased breath sounds were noted in the right lung field; chest Xray revealed rightsided pleural effusion (Figure 1). Pleurocentesis revealed clear and transparent pleural fluid, consistent with a transudative type of effusion. Pleural fluid and serum glucose levels were 325 and 115 mg/dL, respectively, both suggesting that the effusion came from the dialysate fluid because of pleuroperitoneal communication. Isotopic peritoneography with technetium99mlabeled macroaggregated albumin revealed a prompt reflux of the tracer in the right pleural space (Figure 2), which confirmed the presence of a rightsided pleuroperitoneal communication. PD was discontinued and switched

Transjugular Intrahepatic Portosystemic Shunt as the Treatment for Refractory Hepatic Hydrothorax with Portal Vein Thrombosis.

Abstract: Hepatic hydrothorax occurs in 4–12% of patients with liver cirrhosis.[1] A part of patients with persisted hydrothorax resists conservative treatment, known as refractory hepatic hydrothorax (RHH). Portal vein thrombosis (PVT) is observed in about 2.1–16.2% patients with liver cirrhosis,[2] which may aggravate portal hypertension. If RHH and PVT are combined in a cirrhotic patient, transjugular intrahepatic portosystemic shunt (TIPS) may be a reasonable intervention.[3] However, no such successful case has been reported. We herein reported a case of cirrhotic patient complicated with both RHH and PVT, who underwent TIPS and achieved long‐term survival.

Meigs Syndrome: A paradoxical presentation

Abstract: Meigs disorder an uncommon, particularly fascinating disorder of the old, which is portrayed by a triad of a benign ovarian tumor (fibroma, fibrothecoma, Brenner tumour, and occasionally granulosa cell tumour), hydrothorax, ascites. The possible conclusion of this pathology is fundamentally clinical regardless of the precious esteem that imaging strategies have. It also creates a condition of perplexity in the determination by impersonating ovarian tumours and in this manner turns into a diagnosis of exclusion. Hence, precise diagnosis gets to be distinctly important to differentiate it from ovarian malignancy considering the reality of it having a good prognosis. The case herein concerns a 65-year-old postmenopausal woman coming with history of mass per abdomen with acute pain abdomen, with clinical and radiological examination revealing a large pelvic tumour of size 15*12 cm with cystic and solid components associated with bilateral pleural effusion with moderate ascites. Keywords: Fibroma, Ascites, Meigs Syndrome

Recurrent scrotal edema in liver cirrhosis

Abstract: Liver cirrhosis is a potentially lethal disease, which can be complicated by liver failure, hepatic encephalopathy, splenomegaly, variceal bleeding, ascites, and hydrothorax (1,2). Herein, we reported a rare case with liver cirrhosis presenting with recurrent scrotal edema probably due to an extremely albumin level.

Spontaneous bacterial empyema in cirrhotic patients:clinical features and outcomes

Abstract: AIM: The aim of this study is to determine the prevalence of spontaneous bacterial empyema among patients with liver cirrhosis and identify clinical features and outcomes of spontaneous bacterial empyema. patients AND METHODS : The study included 800 patients (males and females) presented with liver cirrhosis with and without ascites and pleural effusion . A total of 100 (57 males and 43 females) patients with liver cirrhosis and hepatic hydrothorax, (99 patients) with and (1 patients) without ascites were enrolled. Spontaneous bacterial empyema was diagnosed by a pleural fluid PMNL count >500 cells/mm3 without radiographic evidence of pneumonia or a contiguous infection process on chest radiography. RESULTS: the frequency of spontaneous bacterial empyema among cirrhotic patients with hepatic hydrothorax was 19% (19 out of 100 cirrhotic patients). CONCLUSION: SBEM was recognized in 19% of cirrhotic patients with ascites and hepatic hydrothorax. So, it is a frequent but underdiagnosed complication of hepatic hydrothorax and has a poor prognosis.

Hydrothorax caused by catheter malposition misdiagnosed via using plain radiography

Abstract: We report the case of a child with hydrothorax caused by the misidentification of catheter malposition using plain radiography. A 9-month-old girl underwent central venous catheterization via the right subclavian vein. Catheter tip was evaluated mistakenly as in the right atrium by plain radiography. The catheter was retracted 2 cm and 1/3 normal saline infusion was initiated at 15 ml/hr. The patient became hypoxemic at the 20th hour of fluid infusion. On radiography, the right lung was completely opaque and the catheter tip was positioned in the right lung. Bedside sonography revealed a massive pleural effusion in the right lung and the catheter tip in the right pleural space. The catheter was removed and the pleural effusion was drained via chest tube. The location of the catheter tip should be determined by an accurate technique before infusing fluid. Plain radiography can be misleading for the detection of malposition.

Compromiso pulmonar en la enfermedad hepática: una actualización

Abstract: Liver disease is a major cause of morbidity and mortality in the world; it is associated with multiple organ involvement. In the lung, three clinical conditions are described; these conditions include, Hepatopulmonary Syndrome (HPS), which is due to a oxygenation defect by the development of pulmonary vascular dilatation. Portopulmonary (HPP) hypertension, it’s mediated by an imbalance between vasodilator and vasoconstrictor agents leading to an increase in mean pulmonary artery pressure and finally the Hydrothorax Liver (HH), that is the least prevalent condition, it’s based on anatomical diaphragm abnormalities, with or without ascites. The presence of SHP or HPP is an independent predictor of mortality, highlighting its importance in the eligibility of patients for orthotopic liver transplantation as a curative measure.

Accidental selenium toxicosis in lambs.

Abstract: Acute selenium toxicosis occurred in 3-week-old lambs after accidental over-supplementation by intramuscular injection and caused dyspnea, cyanosis, and sudden death. Pathological lesions included myocardial necrosis, skeletal muscle necrosis, pulmonary edema, hydrothorax, and hydropericardium.

Idiopathic Exudative Hydropneumothorax and Spontaneous Pneumomediastinum in a Young Iranian Man: A Case Report

Abstract: Hydropneumothorax denotes concurrent presence of pneumothorax and hydrothorax in the pleural space, which can be a fatal situation. In this study, we presented the case of a 35-year-old male with history of progressive pleuritic chest pain 30 days before admission with idiopathic hydropneumothorax and spontaneous pneumomediastinum

Successful induction of peritoneal dialysis in a patient with massive hydrothorax due to pleuroperitoneal communication .

Abstract: A 74-year-old woman with liver cirrhosis and chronic kidney disease (CKD) who had complained of chronic abdominal distension due to prominent ascites presented with sudden dyspnea. Chest radiography showed massive right pleural effusion that shifted the mediastinum. Peritoneal scintigraphy using 99mTc-macroaggregated albumin revealed pleuroperitoneal communication (PPC). As her hydrothorax was refractory and frequent thoracentesis did not improve her respiratory distress, thoracoscopic surgery was performed for repair of the diaphragm defect. Continuous ambulatory peritoneal dialysis (CAPD) was started soon after surgery because her renal function was progressively worsening, and there was no recurrence of hydrothorax. The chronic abdominal distension resolved as her ascites decreased. In addition, peritoneal protein loss decreased after initiation of peritoneal dialysis (PD). PPC is an uncommon but serious complication of PD, and PD patients with PPC are often forced to discontinue PD. To our knowledge, no report has presented successful PD induction in a patient with evident PPC. We believe that further accumulation of such cases will expand the treatment options for CKD. .