Abstract
BackgroundHepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis.Case presentationWe report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic hydrothorax with failure of the lung to re-expand after chest tube placement in three of the four cases. Two patients underwent surgical decortication with one subsequent death from post-operative bleeding. The other two patients remarkably had spontaneous improvement of their “trapped lung” without surgical intervention.ConclusionsWhile pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces. The pathophysiology of this phenomenon remains unclear but could be related to chronic inflammation with development of a fibrous layer along the visceral pleura.
Highlights
Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis.Case presentation: We report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax
While pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces
We report four observations of pneumothorax ex-vacuo or trapped lung associated with hepatic hydrothorax
Summary
Trapped lung was seen in conjunction with pneumothorax therapy used to treat tuberculosis [6]. The spontaneous improvements in the hydropneumothoraces suggest a potential for pleural remodeling and healing resulting in lung expansion over time, similar to that seen in some patients with trapped lung following an empyema To our knowledge, this is the first case series reported of the development of pneumothorax ex-vacuo in association with hepatic hydrothorax. In asymptomatic patients with pneumothoraces ex-vacuo in association with hepatic hydrothoraces, observation with conservative management may be appropriate prior to surgical interventions, especially in light of the bleeding complications that can occur with liver disease It remains unclear whether the development of pneumothorax ex-vacuo would be preventable by keeping the pleural space as dry as possible to minimize chronic inflammation. The work was performed at University of California Los Angeles Medical Center, Los Angeles, California
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