Abstract
Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver disease. Pleural drainage carries the risk of massive protein and electrolyte depletion as well as the risk of bleeding and hepatic encephalopathy. Pleurodesis following pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recurrent pleural effusions. The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided iodopovidone sclerotherapy in hepatic hydrothorax. Patients and Methods: This prospective study included 56 patients with clinical, laboratory and radiological evidence of liver cirrhosis and symptomatic right sided hepatic hydrothorax. All patients were subjected to repeated thoracentesis. Ten ml of lidocaine 2% were injected in the pleural space followed by 20 ml of iodopovidone. The follow-up was done after 3 months. Results: The sclerotherapy procedure was successful in 40 out of 56 cases (71.4%), and the success rate was 66.7% in massive effusion and reached 80% in moderate effusion. Twenty eight patients (50%) had to repeat the procedure for a second time, sixteen of which (28.6%) failed despite the second trial and twelve cases (21.4%) showed no fluid reaccumulation. Conclusion: Ultrasound-guided iodopovidone sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax.
Highlights
Hepatic hydrothorax is a complication of end stage liver disease [1], ranging from 4% to 6%, and up to 10% with advanced disease [2]
The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided iodopovidone sclerotherapy in hepatic hydrothorax
Thoracocentesis has been most effective for rapid relief of dyspnea associated with massive hepatic hydrothorax, with repeated thoracocentesis in recurrent accumulations there is a risk of substantial protein depletion [8]
Summary
Hepatic hydrothorax is a complication of end stage liver disease [1], ranging from 4% to 6%, and up to 10% with advanced disease [2] It refers to the abnormal accumulation of more than 500 milliliters of transudative pleural effusion in patients with liver cirrhosis where a cardiac and pulmonary cause of pleural effusion has been ruled out [1]. This is a right sided effusion, which could be bilateral, and rarely it is isolated left sided effusion. Conclusion: Ultrasound-guided iodopovidone sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax
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