Pleural Effusion Clinical Trial
Official title:
Pigtail Catheter: a Less Invasive Option for Pleural Drainage of Recurrent Hepatic Hydrothorax
The effectiveness of pigtail catheter as a less invasive option for pleural drainage in patients with resistant hepatic hydrothorax.
Hepatic hydrothorax (HH) is defined as a transudative pleural effusion in patients with liver
cirrhosis in the absence of cardiopulmonary disease. The estimated prevalence among patients
with liver cirrhosis is approximately 5-6% (Baikati et al., 2014).
HH is an infrequent but a well-known complication of portal hypertension. Trans-diaphragmatic
passage of ascitic fluid from peritoneal to the pleural cavity through numerous diaphragmatic
defects has been shown to be the predominant mechanism in the formation of HH (Kumar&Kumar,
2014).
Patients with hepatic hydrothoraces often have few options (Goto et al., 2011).
Diuretic-resistant HH could be managed with liver transplantation, transjugular intrahepatic
portosystemic shunt (TIPS) or indwelling pleural catheters. However, tube thoracotomy and
pleurodesis failed in most patients (Singh et al., 2013).
Case reports and small case series have reported a high rate of complications associated with
chest tube placement for hepatic hydrothorax. The most common reported complications were
acute kidney injury, pneumothorax, and empyema. Death has been recorded in some cases. Chest
tube insertion for hepatic hydrothorax carries significant morbidity and mortality, with
questionable benefit (Orman&Lok, 2009).
Pigtail catheter insertion is an effective and safe method of draining pleural fluid. Its use
is safe and recommended for all cases of pleural effusion requiring chest drain except for
empyema and other loculated effusions that yielded low success rate (Bediwy and Amer, 2012).
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