Pleural Fluid Analysis, Radiographic, Sonographic and Echocardiographic Characteristics of Hepatic Hydrothorax.
Chest. 2011 Jan 27;
Authors: Gurung P, Goldblatt M, Huggins JT, Doelken P, Nietert PJ, Sahn SA
Abstract BACKGROUND: There is limited published data defining complete pleural fluid analysis, echocardiographic characteristics or the presence or absence of ascites on sonographic or CT imaging in patients with hepatic hydrothorax. METHODS: We reviewed pleural fluid analysis, radiographic, sonographic and echocardiographic findings on 41 consecutive patients with hepatic hydrothorax referred to the Pleural Procedure Service for thoracentesis. RESULTS: Ascites was detected on sonographic or CT imaging in 38 (97%) of 39 patients. Diastolic dysfunction was found in 11 (52%) of 21 patients. Contrast echocardiography with agitated saline demonstrated an intrapulmonary shunt in 18 (78%) of 23 cases. Solitary hepatic hydrothorax had a median pleural fluid pH of 7.49 (5(th) - 95(th) percentile 7.40-7.57), total protein of 1.5 g/dL (0.58 - 2.34), and LDH of 65 IU/L (36 - 138). The median pleural fluid/serum protein ratio and pleural LDH/ upper limit of normal serum LDH ratio was 0.25 (0.10 - 0.43) and 0.27 (0.14 - 0.57), respectively. Median absolute neutrophil count (ANC) was 26 cells/?L (1- 230). There was only a single patient with a protein discordant exudate despite 83% of patients receiving diuretics. When comparing solitary hepatic hydrothorax and spontaneous bacterial pleuritis, there was no statistically significant difference between pleural fluid total protein (p = 0.99), LDH (p = 0.33) and serum albumin (p = 0.47). ANC was higher in patients with spontaneous bacterial pleuritis (p <0.0001). CONCLUSIONS: Hepatic hydrothorax virtually always presents with ascites that is detectable on sonographic or CT imaging. The development of an "exudate" from diuretic therapy is a rare phenomenon in hepatic hydrothorax. In contrast, diastolic dysfunction and intrapulmonary shunting is common in patients with hepatic hydrothorax. There was no statistically significant change in pleural fluid parameters with spontaneous bacterial pleuritis, except an increased ANC.
PMID: 21273292 [PubMed - as supplied by publisher]