Skip to main content
SpringerLink
Log in

Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of HH.

Aim

To evaluate the effectiveness and safety of pleurodesis for HH in a systematic review with meta-analysis.

Methods

All relevant papers were searched on the EMBASE and PubMed databases. As for the data from the eligible case reports, the continuous data were expressed as the median (range) and the categorical data were expressed as the frequency (percentage). As for the data from the eligible case series, the rates of complete response and complications were pooled. The proportions with 95 % confidence intervals (CIs) were calculated by using random-effect model.

Results

Twenty case reports including 26 patients and 13 case series including 180 patients were eligible. As for the case reports, the median age was 55 years (range 7–78) and 15 patients were male. The prevalence of ascites was 76 % (19/25). Seventeen (65.38 %) patients responded favorably to pleurodesis. As for the case series, the mean age was 51.5–63.0 years and 83 patients were male. The pooled prevalence of ascites was 90 % (95 % CI 81–97 %) in 7 studies including 71 patients. The complete response rate after pleurodesis was reported in all studies, and the pooled rate was 72 % (95 % CI 65–79 %). Complications related to pleurodesis were reported in 6 studies including 63 patients, and the pooled rate was 82 % (95 % CI 66–94 %).

Conclusion

Pleurodesis may be a promising treatment for HH, but carries a high rate of complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Abbreviations

HH:

Hepatic hydrothorax

VATS:

Video-assisted thoracic surgery

TIPS:

Transjugular intrahepatic portosystemic shunt

CI:

Confidence interval

CTH:

Conventional thoracoscopy

References

  1. Morrow CS, Kantor M, Armen RN. Hepatic hydrothorax. Ann Intern Med. 1958;49:193–203.

    Article  CAS  PubMed  Google Scholar 

  2. Cardenas A, Kelleher T, Chopra S. Review article: hepatic hydrothorax. Aliment Pharmacol Ther. 2004;20:271–279.

    Article  CAS  PubMed  Google Scholar 

  3. Lazaridis KN, Frank JW, Krowka MJ, Kamath PS. Hepatic hydrothorax: pathogenesis, diagnosis, and management. Am J Med. 1999;107:262–267.

    Article  CAS  PubMed  Google Scholar 

  4. Poinso R, Chanas P. Pleural manifestations of liver cirrhosis. La Presse Medi. 1958;66:1106–1108.

    CAS  Google Scholar 

  5. Sivanathan V, Kittner JM, Sprinzl MF, et al. Etiology and complications of liver cirrhosis: data from a German centre. Dtsch Med Wochenschr. 2014;139:1758–1762.

    Article  CAS  PubMed  Google Scholar 

  6. Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine. 2014;93:135–142.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hou F, Qi X, Ning Z, et al. Prevalence, risk factors, and in-hospital outcome of pleural effusion in liver cirrhosis: a retrospective observational study. Int J Clin Exp Med. 2016;9:3265–3279.

    Google Scholar 

  8. Liu WL, Kuo PH, Ku SC, Huang PM, Yang PC. Impact of therapeutic interventions on survival of patients with hepatic hydrothorax. J Formosan Med Assoc Taiwan yi zhi. 2010;109:582–588.

    Article  PubMed  Google Scholar 

  9. Ibi T, Koizumi K, Hirata T, Mikami I, Hisayoshi T, Shimizu K. Diaphragmatic repair of two cases of hepatic hydrothorax using video-assisted thoracoscopic surgery. Gen Thoracic Cardiovasc Surg. 2008;56:229–232.

    Article  Google Scholar 

  10. Huang PM, Chang YL, Yang CY, Lee YC. The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding. J Thoracic Cardiovasc Surg. 2005;130:141–145.

    Article  Google Scholar 

  11. Frazer IH, Lichtenstein M, Andrews JT. Pleuroperitoneal effusion without ascites. Med J Aust. 1983;2:520–521.

    CAS  PubMed  Google Scholar 

  12. Ajmi S, Hassine H, Arifa N, et al. Large diaphragmatic defect as the cause of hydrothorax in a cirrhotic patient: demonstration with peritoneal scintigraphy and magnetic resonance imaging. Magn Reson Imaging. 2004;22:431–433.

    Article  PubMed  Google Scholar 

  13. Matono T, Koda M, Murawaki Y. Right diaphragmatic defect in hepatic hydrothorax exposed by contrast-enhanced ultrasonography after radiofrequency ablation. Hepatology. 2012;56:784–785.

    Article  PubMed  Google Scholar 

  14. Huang PM, Han YY, Kuo SW, Lee YC. Color Doppler ultrasonography in detecting transdiaphragmatic flow of hepatic hydrothorax: correlation with thoracoscopic findings. J Thoracic Cardiovasc Surg. 2009;138:1251–1252.

    Article  Google Scholar 

  15. Guest S. The curious right-sided predominance of peritoneal dialysis-related hydrothorax. Clin Kidney J. 2015;8:212–214.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Spencer EB, Cohen DT, Darcy MD. Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax. J Vasc Interv Radiol. 2002;13:385–390.

    Article  PubMed  Google Scholar 

  17. Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: a systematic review and cumulative meta-analysis. World J Hepatol. 2015;7:1797–1806.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Siegerstetter V, Deibert P, Ochs A, Olschewski M, Blum HE, Rössle M. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol. 2001;13:529–534.

    Article  CAS  PubMed  Google Scholar 

  19. Cardenas A, Arroyo V. Management of ascites and hepatic hydrothorax. Best Pract Res Clin Gastroenterol. 2007;21:55–75.

    Article  PubMed  Google Scholar 

  20. Porcel JM. Management of refractory hepatic hydrothorax. Curr Opin Pulmonary Med. 2014;20:352–357.

    Article  Google Scholar 

  21. Wang X, Qi X, Guo X. Tusanqi-related sinusoidal obstruction syndrome in China: a systematic review of the literature. Medicine. 2015;94:e942.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Alba D, Molina F, Ripoll MM, Castillo P, Lizasoain J, Vázquez JJ. Pleuroperitoneal shunt in the treatment of pleural effusion associated with cirrhosis. Anal Med Intern. (Madrid, Spain: 1984) 1993;10:604–606.

  23. Canto A, Arnau A, Moya J, Ferrer G. Talcum pleurodesis in massive recurrent pleural effusions in liver cirrhosis. Res Surg. 1989;1:142–144.

    Google Scholar 

  24. Colombo A, Boncinelli L, Pinzi M, Ideo G. A new therapeutic approach in hepatic hydrothorax. Miner Med. 1992;83:219–222.

    CAS  Google Scholar 

  25. Drouhin F, Fischer D, Law Koune JD, Boiteau R, Tenaillon A, Labayle D. Treatment of hydrothorax in liver cirrhosis with chemical pleurodesis and continuous positive airway pressure. Preliminary results [9]. Gastroenterol Clin Biol. 1991;15:271–272.

    CAS  PubMed  Google Scholar 

  26. Lorang B, Steinbach G, Pierron A, Chopin J. Respiratory failure by massive and recurrent hydrothorax in a patient with hepatic cirrhosis. Report of a case. Converg Med. 1984;3:549–553.

    Google Scholar 

  27. Matsuda M, Tachibana Y, Ogino H, Satomura Y, Unoura M. Treatment for intractable hepatic hydrothorax with nasal continuous positive airway pressure (CPAP) and chemical pleurodesis. Acta Hepatol Japonica. 1998;39:914–918.

    Article  Google Scholar 

  28. Vignoli R, Di Donato C, Tramaloni C, et al. Hepatic hydrothorax: description of a case resolved with pleurodesis with sterile talc. Giornale Clin Med. 1987;68:585–587.

    CAS  Google Scholar 

  29. Falchuk KR, Jacoby I, Colucci WS, Rybak ME. Tetracycline-induced pleural symphysis for recurrent hydrothorax complicating cirrhosis. A new approach to treatment. Gastroenterology. 1977;72:319–321.

    CAS  PubMed  Google Scholar 

  30. Chu CH, Kao CR, Shih SC, et al. Hepatic hydrothorax: clinical experience and analysis. Gastroenterol J Taiwan. 1996;13:171–178.

    Google Scholar 

  31. Kim HJ, Cho YK, Kim BI. Chemical pleurodesis for the management of symptomatic hepatic hydrothorax. Hep Intl. 2011;5:343.

    Google Scholar 

  32. Kottam R, Shah N, Malhotra A, Spira R, Depasquale J. Hepatic hydrothorax without ascites. Am J Gastroenterol. 2010;105:S283.

    Google Scholar 

  33. Ajmi S, Hassine H, Guezguez M, et al. Isotopic exploration of hepatic hydrothorax: ten cases. Gastroenterol Clin Biol. 2004;28:462–466.

    Article  PubMed  Google Scholar 

  34. Bayram AS, Koprucuoglu M, Aygun M, Gebitekin C. Pleurovenous shunt for treating refractory benign pleural effusion. Eur J Cardiothorac Surg. 2008;33:942–943. doi:10.1016/j.ejcts.2008.02.001. Epub 7 Mar.

    Article  PubMed  Google Scholar 

  35. Boin IF, Silva AM, Leonardi LS. Chemical pleurodesis for hepatic hydrothorax. Arq Gastroenterol. 2001;38:125–128.

    Article  CAS  PubMed  Google Scholar 

  36. Conklin LD, Estrera AL, Weiner MA, Reardon PR, Reardon MJ. Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax. Ann Thorac Surg. 2000;69:609–611.

    Article  CAS  PubMed  Google Scholar 

  37. Doraiswamy V, Riar S, Shrestha P, et al. Hepatic hydrothorax without any evidence of ascites. Sci World J. 2011;11:X587–X591.

    Article  Google Scholar 

  38. Fujii T, Inoue S, Sugimoto H, Takeda S, Nakao A. Two cases of refractory hepatic hydrothorax treated successfully with transjugular intrahepatic portosystemic shunt. Jpn J Gastroenterol Surg. 2006;39:464–469.

    Article  Google Scholar 

  39. Fujino T, Tomimatsu M, Chishima K, et al. A case of hepatic hydrothorax who was diagnosed by intraperitoneal indocyanine green (ICG) injection and recovered through chemical pleurodesis. J Tokyo Women’s Med College. 1992;62:1620–1625.

    Google Scholar 

  40. Goto T, Oyamada Y, Hamaguchi R, et al. Remission of hepatic hydrothorax after OK-432 pleurodesis. Ann Thoracic Cardiovasc Surg. 2011;17:208–211.

    Article  Google Scholar 

  41. Haitjema TJ, De Maat CEM. Pleural effusion without ascites in a patient with cirrhosis. Neth J Med. 1994;44:207–209.

    CAS  PubMed  Google Scholar 

  42. Haskal ZJ, Zuckerman J. Resolution of hepatic hydrothorax after transjugular intrahepatic portosystemic shunt (TIPS) placement. Chest. 1994;106:1293–1295.

    Article  CAS  PubMed  Google Scholar 

  43. Hsu KH, Tsai YF, Chiu NT, Chen LW, Lai WW. Thoracoscopic treatment of hepatic hydrothorax without ascites: a case report. Formosan J Surg. 2003;36:203–206.

    Google Scholar 

  44. Ikard RW, Sawyers JL. Persistent hepatic hydrothorax after peritoneojugular shunt. Arch Surg. 1980;115:1125–1127.

    Article  CAS  PubMed  Google Scholar 

  45. Lin CC, Wu JW, Chang SC, et al. Resolution of refractory hepatic hydrothorax after chemical pleurodesis with minocycline. Chin Med J (Taipei). 2000;63:704–709.

    CAS  Google Scholar 

  46. Lin PY, Kuo PH, Yu CJ, Yang PC. Long-term remission of hepatic hydrothorax after OK-432 pleurodesis. J Thorac Cardiovasc Surg. 2008;136:1367–1369. doi:10.016/j.jtcvs.2007.12.078. Epub 8 Aug 29.

    Article  PubMed  Google Scholar 

  47. Papakonstantinou NA, Hardavella G, Papavasileiou G, Anastasiou N. Medical thoracoscopy for the treatment of complicated hepatic hydrothorax. J Surg Case Rep. 2012;2012:2. doi:10.1093/jscr/2012.3.2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Pop CM, Gherasim RM, Dumitrascu DL. Hydrothorax without ascites in liver cirrhosis. Rom J Gastroenterol. 2003;12:315–317.

    PubMed  Google Scholar 

  49. Saito R, Rai T, Saito H, et al. Two cases of intractable hepatic hydrothorax successfully treated with nasal CPAP. Nihon Shokakibyo Gakkai Zasshi. 2006;103:1146–1151.

    PubMed  Google Scholar 

  50. Shirota Y, Kakinoki K, Wakabayashi T, Waseda R, Imai T. A case of intractable hepatic hydrothorax successfully treated by chemical pleurodesis after spontaneous bacterial empyema. Acta Hepatol Japonica. 2007;48:65–70.

    Article  Google Scholar 

  51. Sira MM, Behairy Bel S, Bakir RM, El-Hagaly MA, Sira AM. Hepatic hydrothorax in the absence of ascites in a child with autoimmune hepatitis: successful management with octreotide and pleurodesis. Turk J Gastroenterol. 2013;24:174–183.

    Article  PubMed  Google Scholar 

  52. Temes RT, Davis MS, Follis FM, Pett SB Jr, Wernly JA. Videothoracoscopic treatment of hepatic hydrothorax. Ann Thorac Surg. 1997;64:1468–1469.

    Article  CAS  PubMed  Google Scholar 

  53. Assouad J, Barthes Fle P, Shaker W, Souilamas R, Riquet M. Recurrent pleural effusion complicating liver cirrhosis. Ann Thorac Surg. 2003;75:986–989.

    Article  PubMed  Google Scholar 

  54. de Campos JRM, Filho LO, de Campos Werebe E, et al. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax. Chest. 2000;118:13–17.

    Article  Google Scholar 

  55. Cerfolio RJ, Bryant AS. Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax. Ann Thorac Surg. 2006;82:457–459.

    Article  PubMed  Google Scholar 

  56. Ferrante D, Arguedas MR, Cerfolio RJ, Collins BG, Van Leeuwen DJ. Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax. Am J Gastroenterol. 2002;97:3172–3175.

    Article  PubMed  Google Scholar 

  57. Lee WJ, Kim HJ, Park JH, et al. Chemical pleurodesis for the management of refractory hepatic hydrothorax in patients with decompensated liver cirrhosis. Korean J Hepatol. 2011;17:292–298.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Liu WL, Kuo PH, Ku SC, Huang PM, Yang PC. Impact of therapeutic interventions on survival of patients with hepatic hydrothorax. J Formos Med Assoc. 2010;109:582–588.

    Article  PubMed  Google Scholar 

  59. Luh SP, Chen CY. Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases. J Zhejiang Univ Sci B. 2009;10:547–551.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Ma SW, Kim HJ, Park JH, et al. Chemical pleurodesis for the management of symptomatic hepatic hydrothroax. J Gastroenterol Hepatol. 2010;25:A20.

    Article  Google Scholar 

  61. Mitani R, Yabushita K, Morimoto Y, et al. Effective chemical pleurodesis (CP) using non-invasive positive pressure ventilation (NPPV) for refractory hepatic hydrothorax patients. Gastroenterology. 2011;140:S458–S459.

    Google Scholar 

  62. Mouroux J, Perrin C, Venissac N, Blaive B, Richelme H. Management of pleural effusion of cirrhotic origin. Chest. 1996;109:1093–1096.

    Article  CAS  PubMed  Google Scholar 

  63. Northup PG, Harmon RC, Pruett TL, Schenk WG 3rd, Daniel TM, Berg CL. Mechanical pleurodesis aided by peritoneal drainage: procedure for hepatic hydrothorax. Ann Thorac Surg. 2009;87:245–250. doi:10.1016/j.athoracsur.2008.10.013.

    Article  PubMed  Google Scholar 

  64. Takayama T, Kurokawa Y, Kaiwa Y, et al. A new technique of thoracoscopic pleurodesis for refractory hepatic hydrothorax. Surg Endosc. 2004;18:140–143.

    Article  CAS  PubMed  Google Scholar 

  65. Vargas FS, Milanez JRC, Filomeno LTB, Fernandez A, Jatene A, Light RW. Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest. 1994;106:1771–1775.

    Article  CAS  PubMed  Google Scholar 

  66. Shimbo A, Matsuda S, Tejima K, et al. Induced negative pressure proposed as a new method for diagnosing hepatic hydrothorax involving minor leaks. Clin Case Rep. 2014;2:296–302.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was partially supported by the grants from the National Natural Science Foundation of China (No. 81500474), Natural Science Foundation of Liaoning Province (No. 2015020409), and China Postdoctoral Science Foundation (2015M582886) for Dr. Xingshun Qi.

Author information

Author notes

    Authors and Affiliations

    1. Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China

      Feifei Hou, Xingshun Qi & Xiaozhong Guo

    2. Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China

      Feifei Hou

    Authors
    1. Feifei Hou
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Xingshun Qi
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Xiaozhong Guo
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Xingshun Qi or Xiaozhong Guo.

    Ethics declarations

    Conflict of interest

    None.

    Additional information

    Feifei Hou and Xingshun Qi contributed equally to this work.

    Xiaozhong Guo and Xingshun Qi are Joint Senior authors.

    Electronic Supplementary Material

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Hou, F., Qi, X. & Guo, X. Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis. Dig Dis Sci 61, 3321–3334 (2016). https://doi.org/10.1007/s10620-016-4260-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10620-016-4260-9

    Keywords

    Search

    Navigation