A Clinical Analysis Of 52 Cases Of Hepatic Hydrothorax

Hepatic hydrothorax(HH) is a common manifestation of cirrhosis with ascites, defined as pleural effusion in a patient with cirrhosis of the liver in the absence of any other explanation for the accumulation of pleural fluid. Hepatic hydrothorax occurs in many patients with advanced stage cirrhosis of the liver. Most sufferers palindromia after active treatment, and still no specific treatment measure done. The prevalence of pleural effusion caused by hepatocirrhosis ranges from 0.4% to 30%. Hepatic hydrothorax results from an accumulation of fluid migrating through a diaphragmatic defect from the abdominal cavity into the pleural cavity. The mechanisms proposed for accumulation of pleural fluid include:(1)hypoproteinemia;(2) portal hypertension;(3)transdiapharagmatic migration of ascitc fluid into the pleural space via lymphatics;(4) pneumonedema;(5)diaphragmatic rents. HH without ascites might be caused by a rapid transdiaphragmatic movement of fluid from the peritoneal cavity to the pleural cavity prior to the formation of ascites. This article had retrospective analysed the characteristic of HH, explained correlationfactors that influenced occurrence and volume of HH.Objective and methods: To study the clinical features and prognosis of patients with HH. 52 cases with hepatic hydrothorax of cirrhosis between 2003. 1 and 2006.12. Diagnosed by clinical, biochemical, histological and CT, were selected.Other metabolic disorders, tuberculous pleurisy, cardiovascular disease, pulmonary disease and malignant tumor must be exclusived.Results: Of the 52 subjects evaluated, there were 41 males and 11 female, with a mean age of 52.9±10.21 years. The occurrence of HH has the obvious relevance with the smoking quantity, the incidencerate was high in massive smoker. The major etiology of cirrhosis was chronic viral hepatitis. The effusion was generally unilateral and usually right side(86.5%). The clinical manifestations of HH were mild, or lack of symptoms was frequent.The presenting symptom was ascites in 92.3% and fever in 42.3%. The effusion of hepatic hydrothorax is typically transudative whereas the effusion of spontaneous bacterial emphysema (SBEM) was exudative. The albumin and cholinesterase were statistically different between patients with different amount of pleural fluid (P<0.05). Analyzingkidney function and blood sodium concentration in each group, shown significant difference (P<0.05). Splenomegaly and portal hypertension were independently associated with the amount of pleural fluid. The more the pleural fluid was and the worse the curative effect.Conclusions: The peak ages of hepatic hydrothorax of cirrhosis was 40-70 years old. The overall hospital mortality was 5.7%. The occurrence of HH has the obvious relevance with the smoking quantity. Usually it was found in the right hemoithorax (84.6%), but could also be seen on the left side (approximately 5.7%), bilaterally (approximately 9.7%), and usually with ascites. The effusion of hepatic hydrothorax is typically transudative. Laboratory features of the fluid are similar to those of ascites. Plasma albumin, sodiumion concentration, kidney function as well as portal hypertension has obvious relevance with pleural fluid quantity.