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Ann Thorac Surg 2000;69:609-611
© 2000 The Society of Thoracic Surgeons

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Case Reports

Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax

^a Division of General Surgery, Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA
^b Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA
^c Division of Cardiovascular Radiology, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA
^d Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA
^e Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA

Address reprint requests to Dr Reardon, Department of Surgery, Baylor College of Medicine, 6550 Fannin, Suite 1619, Houston, TX 77030
e-mail: reardonm{at}bcm.tmc.edu

For many years, pleural effusions have been recognized as a complication of cirrhosis, occurring in approximately 5.5% of patients. Recent studies have confirmed that small defects in the diaphragm allow for passage of ascitic fluid into the pleural space. Successful management of these patients is challenging, as many of the treatment options can be associated with increased morbidity. The initial treatment should focus on eliminating and preventing the recurrence of ascites with diuretics and water and salt restriction. For those patients who do not respond medically, more invasive techniques have been used including serial thoracentesis, chest tube placement, chemical pleurodesis, and peritoneovenous shunts. We present a patient with recurrent pleural effusions secondary to hepatic cirrhosis who was unsuccessfully treated medically, and subsequently treated with thoracentesis, chest tube drainage and pleurodesis, with ultimate resolution after transjugular intrahepatic portosystemic shunt placement.

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