Hepatic
hydrothorax is an infrequent complication of
portal hypertension in
liver cirrhosis. Treatment with saline restriction and
diuretics is usually effective but when this fails, the therapeutic approach is difficult and multiple complications occur. Transjugular percutaneous intrahepatic
portosystemic shunt (IPS) is associated with a marked decrease in portal pressure and consequently this technique has been used in the treatment of refractory
ascites. The aim of this study was to analyze the efficacy, safety and outcome of refractory hepatic
hydrothorax treated by IPS. The procedure was performed in 5 patients who were all grade B or C in the Child-Pugh classification. Three patients showed complete response to the treatment, of whom 1 underwent
transplantation 20 days later. The fourth patient showed partial response with a reduction in the need to perform thoracocentesis and the fifth patient showed no response to IPS and died after 17 days of follow-up.
Albumin levels and Child classification remained unchanged. Two patients presented recurrence with reappearance of
hydrothorax due to shunt dysfunction and 2 patients presented
hepatic encephalopathy that responded to medical treatment. Refractory hepatic
hydrothorax can be controlled by IPS in a large number of patients but its efficacy is restricted by shunt dysfunction, the risk of
encephalopathy and by its limited effect on survival.