Abstract
Pleural effusion is a relatively uncommon complication of end-stage liver disease, which occurs in less than 10% of the patients. Patients with refractory hydrothorax require more invasive management with options such as repeated thoracentesis in selected patients, which usually carries risk for pneumothorax and contamination. Many studies have shown that doxycycline pleurodesis is an effective and safe method for achieving apposition of the pleural surfaces. This prospective study included 60 patients with hepatic hydrothorax. All patients were subjected to repeated thoracentesis (two to four times) followed by the placement of a 16-G cannula under ultrasound guidance for proper drainage of any detected remnants of pleural fluid collections. In total, 10 ml of lidocaine 2% were injected in the pleural space followed by 1000 mg of doxycycline diluted in 100 ml saline solution. Pleurodesis session was repeated after 1 week if any radiological evidence for reaccumulation was noticed. The sclerotherapy procedure was successful in 46 out of 60 cases (76.7%); the success rate was 72.2% in massive effusion and reached 83.3% in moderate effusion. A total of 26 patients (43.3%) had to repeat the procedure for a second time, 14 of which (23.3%) failed despite the second trial and 12 cases (20%) showed no fluid reaccumulation. Ultrasound-guided doxycycline sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax (overall rate of 76.7%). The procedure is safe and precludes the need for intercostal tube insertion and thus offering less discomfort for patients.
Highlights
Pleural effusion is a relatively uncommon complication of end-stage liver disease, which occurs in less than 10% of the patients, typically located on the right side in ∼70–80% of the cases
Aim of the study The aim of the present study was to detect the efficacy of ultrasound-guided pleurodesis using doxycycline as a sclerosing agent. Patients and methods This prospective study included 60 patients with clinical, laboratory and radiological evidence of liver cirrhosis complicated by hepatic hydrothorax, and who were admitted to Chest and Tropical Departments of the Cairo University Hospital during the period from March 2010 to November 2014
All patients were subjected to repeated thoracentesis two to four times according to the size and rate of reaccumulation of the effusion, provided that the maximum amount of drained fluid per session did not exceed 2000 ml
Summary
Pleural effusion is a relatively uncommon complication of end-stage liver disease, which occurs in less than 10% of the patients, typically located on the right side in ∼70–80% of the cases. Several mechanisms have been postulated for the development of hepatic hydrothorax in patients with liver cirrhosis. These include the transfer of the peritoneal fluid into the pleural space through diaphragmatic defects, hypoalbuminaemia resulting in decreased colloid osmotic pressure and lymphatic leakage from the thoracic duct [2]. Pleural effusion is a relatively uncommon complication of end-stage liver disease, which occurs in less than 10% of the patients. Many studies have shown that doxycycline pleurodesis is an effective and safe method for achieving apposition of the pleural surfaces
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