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Arch Hellen Med, 20(6), November-December 2003, 625-632


Hydrothorax and spontaneous bacterial empyema in cirrhotic patients

Academic Department of Medicine, Hippokration General Hospital, Athens, Greece

Cirrhotic hydrothorax is defined as a significant pleural effusion in patients with cirrhosis of the liver and no primary cardiopulmonary disease. Its prevalence in patients with decompensated cirrhosis is 4% to 10%. Cirrhotic hydrothorax is caused by movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. Diagnosis is confirmed by thoracentesis and intraperitoneal injection of radioisotope. The management includes sodium restriction, use of diuretics and thoracentesis. The transjugular intrahepatic porto-systemic stent is the most appropriate therapeutic approach to refractory cirrhotic hydrothorax. The only long-term solution in patients with refractory cirrhotic hydrothorax is liver transplantation. Spontaneous bacterial empyema is the infection of cirrhotic hydrothorax, as a result of either bacteremia or movement of infected ascitic fluid through diaphragmatic defects. Diagnosis is confirmed by pleural fluid examination and culture. Antibiotic therapy is sufficient and tube thoracostomy should be avoided.

Key words: Ascites, Cirrhotic hydrothorax, Spontaneous bacterial empyema,Transjugular intrahepatic porto-systemic stent.

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