Hepatic
hydrothorax is a rare complication of
portal hypertension.
Conservative therapy may be successful but refractory hepatic
hydrothorax is not uncommon. Management of refractory
hydrothorax is usually ineffective and can result in a worsened clinical status. Transjugular intrahepatic
portosystemic shunts (
TIPS) lower portal pressure and have been used in the treatment of refractory
ascites. The aim of this study was to determine the efficacy of
TIPS in the treatment of symptomatic refractory hepatic
hydrothorax. A
TIPS was placed in 24 consecutive cirrhotic patients with symptomatic refractory hepatic
hydrothorax. Five patients (20.8%) were Child's/Pugh class B and 19 (79.2%) were class C. All had undergone multiple thoracenteses and were hypoalbuminemic. Mean follow-up was 7.2 months (range, 0.25-49 months). Fourteen (58.3%) of 24 patients had complete relief of symptoms after shunt placement and did not require further thoracentesis. Five (20.8%) additional patients required fewer thoracenteses. Five (20.8%) patients developed worsening liver function and died within 45 days. In eight (66.7%) of 12 patients with > or = 60 days of follow-up, the
serum albumin increased by a mean of 1.2 g/dL (range, 0.1-2.2 g/dL). The Child's-Pugh score improved in 7 (58.3%) of these 12 patients and two patients improved from class C to class A. These two patients no longer require
liver transplantation. This study shows that
TIPS can be effective in the management of symptomatic, refractory hepatic
hydrothorax. Clinical and laboratory improvement may be seen and
liver transplantation may become unnecessary.