Manmeet Padda, Shahrooz Bemanian, Brian Tabila, Geetika Mohin, Neil Kaplowitz
CaseRepClinPractRev 2007; 8:334-339
Hepatic hydrothorax (HH) is an uncommon complication of the liver cirrhosis. The main goal of the therapy is to control the ascites. The therapeutic modalities like sodium-fluid restriction and diuretics can lead to pre-renal azotemia. This may lead to failure to optimize the diuretic dose and hence failure to control ascites and HH. Role of somatostatins is not well defined in refractory HH, in the absence of hepatorenal syndrome.
We report the case of a patient with liver cirrhosis, who developed the symptomatic hepatic hydrothorax. Hydrothorax did not improve with diuretic therapy. Transjugular intrahepatic portosystemic shunt and liver transplantation options were not feasible in our patient. Her hospitalization course was complicated with pre-renal azotemia. The treatment with intravenous octreotide improved hydrothorax and pre-renal azotemia.
The management of HH can be very difficult due to complications associated with available therapeutic options. The somatostatin analogues should be considered, when the available therapeutic options could not lead to improvement of HH. We also reviewed the previous case reports in which the somatostatin analogues were used in the management of the hepatic hydrothorax.
Keywords: Hydrothorax, octreotide, Pre-renal azotemia