Hydrothorax is the name implies "hydro" meaning water is the accumulation of water in the pleural cavity. The main or commonest etiology to this surgical situation is in terminal stages of liver cirrohis. In Liver cirrhosis, ascites (accumulation of fluid in the abdominal cavity) occurs and this fluid keeps on accumulating until water 'leaks' into the pleural cavity in the thoracic region. When this happens, hydrothorax results. It is an emergency situation which needs surgery. This hub is meant to show diagrammatic representation of hydrothorax as seen through a chest x-ray.
Hydrothorax On X-Ray
Hepatic hydrothorax is defined as a transudative pleural effusion, usually greater than 500 mL, in patients with portal hypertension without any other underlying primary cardiopulmonary cause. | Source
It develops most likely because of diaphragmatic defects that allow for passage of fluid from the peritoneal space to the pleural space. Because of the mechanical constraints of the thoracic cavity, | Source
this complication of portal hypertension can be challenging to treat because patients will become symptomatic when as little as 500 mL of fluid is present in the pleural space. | Source
Treatments include salt restriction, diuretics, thoracentesis, transjugular intrahepatic portosystemic shunt, video-assisted thoracoscopy, and pleurodesis. | Source
It is important to note that a chest tube is not a potential treatment option; a hepatic hydrothorax should not be treated with a chest tube unless there is frank pus in the pleural fluid or a pneumothorax is present. | Source
The ultimate treatment is a liver transplant; the development of a hepatic hydrothorax thus warrants a referral to a liver transplant center. | Source
Patients with end-stage liver disease often suffer from complications of portal hypertension. In these patients, 50% ultimately will develop ascites and 25% will develop a variceal hemorrhage. Hepatic hydrothorax is a less common complication of port | Source
Hepatic hydrothorax is a less common complication of portal hypertension occurring in 5 to 10% of patients with cirrhosis. Despite its infrequency, it remains a challenging problem for clinicians, and its development warrants a liver transplant evalu | Source
Hepatic hydrothorax is defined as a transudative pleural effusion, usually greater than 500 mL in patients with portal hypertension without any other underlying primary cardiopulmonary cause. | Source
The presence of portal hypertension and not cirrhosis is the sine qua non for the development of hepatic hydrothorax; it should be noted, however, that most patients (> 80%) with portal hypertension have cirrhosis. | Source
Although patients with ascites can often tolerate 5 to 8 L of fluid in their abdomen before becoming significantly symptomatic, a patient with a hepatic hydrothorax will develop dyspnea, shortness of breath, and/or hypoxia when only 1 to 2 L of fluid | Source
hypoxia when only 1 to 2 L of fluid accumulate in the pleural space. This is expected given the structural characteristics of the thoracic cavity. As a result, this complication of portal hypertension is challenging for both patients and clinicians. | Source
As opposed to pleural effusions of cardiac origin that are typically bilateral, 79.5% of pleural effusions in a patient with cirrhosis are right sided only, 17.5% are left sided only, and 3% are bilateral. | Source
This can be helpful in establishing the diagnosis of hepatic hydrothorax versus cardiac disease. | Source
It is believed that the underlying mechanisms leading to fluid retention in patients with hepatic hydrothorax are similar to those leading to other forms of fluid accumulation in patients with cirrhosis. | Source
1. All X-ray photos here are from DFM E-Group, in the photo and X-ray section.
2. Notes and explanations: Wikipedia, Essentials of Clinical Medicine by Kumar and Clark's, Medicinenet and Mayor's Clinic.